Has anyone had micro fat grafting?

I asked my Dr. if he was familiar with Dr. Khouri's method and this is how he replied: 

Yes, I met Dr. Khouri at a meeting in Jan. I also am familiar with the
Brava. I agree with his fat grafting results. The Brava is used by my
colleagues a the Shriner's Hospital and the results are not as good as Dr.
Khouri has been able to do himself.

Thanks
Wes

Hi Kareenie - I think Dr. K is removing my implant and not replacing it with a smaller implant on the first surgery because of the alloderm and also my incision has been draining and there is possible infection going on. He mentioned  putting a smaller implant in with more fat grafting on the second surgery.  At this point in time, I just want them (implants) out!  The small implant on my native side is coming out too and fat grafting. The radiation and implant just did not mix well in my case. I will check out the fatgrafting website.  Thanks

I went to a talk yesterday with a couple of surgeons who were explaining the different procedures used for recon. I asked about the microfatgrafting. One of the docs, who just returned from a few years of practice in L.A, knows about it and the brava system .No one here in Ontario is doing it and she said if it starts here, it will have to start as a clinical trial but there are no plans to start that yet

For some reason my page wasn't showing that this thread had been updated so I missed weeks of postings!  I've got to catch up!

bher- Glad to hear you have a surgery date with Dr. K!  That's exciting!  

BJB1- I understand your anger in knowing there was something out there that was a better option for recon and not having it.  You said your error was in not doing more research but I think the error lies in the fact that surgeons are not required by law to tell us all our options- whether they can provide them or not.  This is something that needs to be changed for all our sakes!  I'm just glad I did go years being miserable before I found Dr. K.  He has made such a difference in my life.

I think Lee already answered this but Dr. K let me choose where I wanted the fat taken from.  I told him my stomach since that's the hardest area for me to lose.  He said there wasn't enough there (which I found hard to believe) so I told him to pick additional spots where ever he thought best.  

Some of you were wondering about the replacing vs removing the implants.  What Dr. K told me is he used to just remove the implant with the first procedure but he found it was too devastating psychologically for his patients.  He said it felt like a giant step backwards for most of them because they would have so much loose skin for months.  He found it was better for them emotionally if he replaced with a smaller implant once or twice until the whole breast was fat.  That's why with my first surgery he swapped them out.  I have lots of Alloderm so that wasn't a factor in why he chose to do it this way as far as I know. 

chinablue- I had Dr. K but here is my experience.  Most of the discomfort came from the lipo itself but it's pretty short lived.  I was very sore the first 2 days but every day after that was better than the one before.  I was bruised where the fat had been taken from but, again, these went away pretty quickly.  The worst bruising (I had the fat taken from my stomach, hips and thighs) seemed to be my inner thighs.  The lipo areas were tender under the skin for about 2-3 weeks, though, and I still have a tiny scar at each spot which should go away with time.  After the lipo you'll usually have some drainage for about the first 24-48 hours as well.  

Chinablue - Like Kate, Dr. Khouri did my revision.  To me the lipo pain was like the soreness after a super intense workout.  First two days hurt, but then then each day gets better.  Bruising took 2-3 weeks to clear up, but sometimes tenderness and numbness can linger for quite a while.  Really nothing to be anxious about.  Take the pain meds the first couple of days and then you will be fine.  Good luck!

pinkbutterfly- Definitely write down all your questions for Dr. K.  It's easy to forget once you're in there.  This will probably be your only appointment prior to seeing him on surgery day so take advantage.  I would also ask him for an email address you can use to write to him in case you think of any other questions later.  He runs late a lot of time so bring something to do.  I had to wait 2 hours for my consult (but he was worth it!).  He will do an exam and take pictures.  If you decide to move ahead with surgery Cindy will give you a list of pre-op testing you need to have done about a week before the surgery.  I would also try to get everything pre-authorized by your insurance company, find out what is in network and what it's all going to cost so there's no surprises.  Good luck with your appointment!

chinablue - I've had fat taken from inner and outer thighs, inner knees and lower back (muffin top).  No permanent numbness anywhere.  Areas that took the longest to heal were inner knees (actually just one leg, lol) and lower back. 

chinablue- My surgery was mid May and I just have a little bit of numbness left on the inside of the thighs.  All my lipo areas were really numb right after so it seems to be improving every week.

Pandazankar - Brava was initially used for breast enhancement and goes way back.  Women just used the domes to expand their breasts and that was it.  No further treatment at all.  Since the expansion worked, the idea of injecting fat into this fertile tissue was developed and that was the initial clinical trial.  Since then the trial has been expanded and since the results from the enhancements were so encouraging, thankfully, breast reconstruction is now a part of it as well.  That Brava works to expand the tissue is proven - just look at the expansion photos of some of the ladies on the fatgraftpatients forum.  To have fat injected into the expanded tissue and have it survive is also dependent upon the fat grafting technique.  Lots of doctors don't use the Brava - lots of ladies report the fat grafting doesn't take.  I've never had "traditional" fat grafting, but I can certainly attest to the fact that I've lost very, very little of the fat that Dr. Khouri injected AND I can personally tell you that the Brava dome pulled my indentation out and provided the space necessary for the grafts.  

I can only imagine the lengthy process and the jumping through hoops necessary to get FDA approval.  

Yes, fat grafting is considered safe but I'd rather have it done in a manner that assures me the highest chance of the fat surviving.  Using Brava (even if just on one area) along with the tedious, yet essential, droplet by droplet method of grafting certainly did that for me.

I know it's tough to wade through all the differing and sometimes contradictory information out there, but for me and for many other women, this has been a miracle.

My understanding was that brava was evaluated for 510(K) compliance at FDA and the FDA has decided not to regulate it at this time.  Not sure if that statement applies to using the brava for breast augmentation through.  FDA doesn't regulate all devices in the same way and I think it doesn't regulate some devices at all. 

Hi pandazankar

Honestly, I was just posting back what I read in this thread last year: in this post (click here).

And the study I referred to is the one Kate linked to. The only approval it currently has is for costmetic expansion, independent of fat grafting. Sorry for any confusion.

I find it hard to believe that a device of this type would not require approval for use in women with a history of breast cancer. Having said that, it would certainly require a lengthy trial and approval process that would likely cost millions of dollars, thousands of patients, and a long follow-up period. I asked a few questions along this line of Alexandra a while back and I never did see a response posted.

I have done extensive research in the form of asking experts ( my breast surgeon, my medical oncologist, my radiation oncologist, an oncologist at MD Anderson, my plastic surgeon, the Susan love foundation, and I'm sure a few others that I can't recall) as well as reading all the scientific literature available on the Internet in English. Most stated that it was their belief that fat grafting is safe. However, this is not based on the types of randomized controlled clinical trials that would be required to prove this definitively. This is separate from the issue of whether Brava itself is safe for women with a history of breast cancer. One of the experts I asked said that not enough was known about Brava and who it would be safe for. My RO, not knowing anything about the specifics of this procedure, found it very far fetched that it might cause cancer cells to grow. So, it is basically used off-label, which is legitimate as long as patients are informed of the risks (not all of which may be known). In Europe, patients who undergo fat grafting are required to be monitored through a clinical trial so that outcomes can be measured, however, there is no standard treatment, nor is there a control group.

I think it is safe to say that these questions will not be resolved for years to come.

Not to sound like an infomercial, but these are my own opinions and the results of my own research, and it is certainly not my intention to mis-represent any facts, so if anyone has more info or knowledge on these issues, please post.

In the end, it's going to be an informed decision to be made on an individual basis whether someone feels comfortable with this or not. Doesn't resolve the insurance coverage question, though.

I've been struggling with this issue myself ever since I learned about this procedure. There, got it off my chest. I'll be quiet now.

Pandazankar,

Getting a medical device approved for a new indication in healthy patients is one thing, but my gut tells me that getting it approved in patients with a known history of cancer would be more difficult. Like you, I too would like to see this. Until more studies are done, we are basically left to fend for ourselves. I'm grateful for the options we do have, but sometimes it feels like we're still in the dark ages with cancer and reconstruction. I feel your pain.

pandazankar- Not sure how it all works but wouldn't they first have to do clinical trials before applying for approval from the FDA?  On both the Brava site, and the government clinical trials site, they say there are clinical trials underway testing Brava to be used in conjunction with fat grafting.  Here's what the Brava site says-