Has anyone had micro fat grafting?

truebff - I don't know if any other surgeons are doing it.  I'm sure that those who have attended his workshops are aware of it.  This is just one of the techniques he has developed and incorporates in the treatment of his hand and breast patients.  With revision surgeries he uses it a lot - he did for me and many others, but in conjunction with revision surgery and/or brava wear.  His hand surgery site is miamihandcenter.com and the other is miamibreastcenter.com

trubff - you may not need the Brava - according to some people I've seen post - a few docs are doing some grafting without Brava.   Dr. A in California is doing stem cell grafting without Brava, but that is only if you are 5 years post surgery (see the story on Suzanne Somers).   I think some other doctors are doing grafting for divots without brava, based upon an abstract I read recently, which does not mention brava: 

Autologous fat grafting in secondary breast reconstruction

Note in the article that they say repeat injections (aka surgeries) are often required, esp. with radiation.  In my personal opinion, I feel like the Brava helps improve the fat retention rate b/c it keeps the blood flow going while the graft is taking.  So, I think I would prefer to go that route to increase the chances of a greater proportion of fat "taking" and having to have fewer surgeries to achieve the same result.  YMMV.  

Dancetrancer - Gothamgirl (Pam) and TFM (Theresa) both used Dr. Ahn (who has trained w/Dr. Khouri). She does use BRAVA. TFM had bc w/implant recon, had them removed and has had a few rounds of fg w/Dr. Ahn so far (looks great!). Gothamgirl had augmentation w/her and also looks great (she doesn't have pics posted yet, but I met her a few times in NYC). Both have used BRAVA for their surgeries.

Dr. Ahn seems to be a bit of an artist and perfectionist as Dr. Khouri is!

Alexandra

Thank you all for the 101 and great information!!

The other ladies can explain the types of fat grafting more eloquently. DIEP is a flap of skin, fat and blood vessels taken from the abdomen to reconstruct a breast or breasts. There is also a surgery known as a stacked DIEP which is when both sides of the abdomen is needed to create one breast and is sometimes necessary when one is thin or large breasted. I did not have enough tissue in any particular area to be a good flap candidate.

Thank you, Lilli, for such a clear explanation. Which did you have? I wish that more doctors were as clear as you are. It gets very confusing out there and although I think many just don't want to overwhelm their patients with the technical details, understanding helps because then choices are much more clear. (I have been amazed how many -even the nicest, most competent doctors- seem to lack in supplying adequate information to their patients.)

I am wondering if there is a benefit to be had from injecting the droplets into tight areas. In my case, I had my incision at lower breast at 9 o'clock position, where I have indent, but also upper breast is tight from rads.

The PS I am working with in May (had early consult so far) said after fat is removed, it is placed in centrifuge and "processed" in the operating room before injecting it into the breast. I'm not sure if this would apply to stem-cell or simply fat grafting.

truebff:

I had plain fat micro-fat grafting. According to Dr Khouri, "Fat grafting can be compared to sowing seeds in a field. Assuming you start with good seeds and you are planting them well, the size of the field and the quality of the soil will determine the crop size. Over-seeding will not help. Stuffing large volumes of fat inside a small "A" cup breast will lead to graft failure and necrosis."
Quoted from: http://www.aesthetictrends.com/monthly_updates/Summer2010/Summer2010PlasticSurgeryBreastFINAL.pdf

From what I understand, the centrifuge can be used with either method. Do you know which method your PS plans to use?

Thank you everyone,  yes   " the hazing is a bitch, but the sisterhood is for life. "  I can see that, Kate!    

So many options, so many questions.  I actually have to decide whether to do rads in the next couple of weeks - I've been told they have to be done no more than 8 weeks or so after surgery.  I'm just really leaning toward not doing them.    

I thought I read somewhere that Dr. Ahn doesn't do full breast reconstruction with fat grafting?  Am I getting the posts and Drs. mixed up?   I'll pm you Eileen.   I'll check out the other thread and check out the other site as well.   I also have to check out the 'drugs' posts - I have an appt with the med onc next week and should go prepared with questions.  Though I don't really want drugs either.  I believe I can do that instead of rads.  ~sigh~ .  I know, in the scheme of things, DCIS is the least horrible of all the possibilites but it seems the treatments are almost as drastic.  

My bs did such a good job on the lumpectomy it barely looks different than before.  I'm about 5 weeks out from that and still a bit sore if I bump it (why did I think I'd be totally back to normal in a day or two?)   but I can barely see the incision.  I kind of hate to muck around with it - lol! - but I really don't think I want rads.   I think what I'd like to do is talk to a few fat graft drs - so I'll check out the Drs. thread.  I have to travel between both coasts over the next few months anyway. 

What I"m not understanding here is, if the Brava is used to create space, then why does it have to be used if you do fat grafting at teh same time as mx?  Isn't the space there if you're saving the skin and - this sounds awful, but - taking out the insides?  Isn't that what you're doing?  Or am I just even more ignorant than I thought about all of this?  

Meny, when you do immediate fat grafting at time of MX, they can only put in so much fat, no matter how big your breasts were to start with.  This is because if you stuff the area full of too much fat, it will not have a good enough blood supply to live/survive.  The graft has to "take".  This means it needs a good blood supply so that it gets nutrients and oxygen.  At time of immediate MX, Brava is not used b/c the tissues are too traumatized by the MX to tolerate it safely (and to allow the MX scar to heal).  So, the fat is injected into and under the pecs, which provide the blood supply for the initial graft.  Again, there is only so much blood supply the pecs can provide, so if you overstuff the area with fat it will just end up dying anyways.  

 Later, for subsequent grafts, you will need the Brava b/c as you heal from the MX, the skin/tissues start to adhere down.  Brava pulls them loose, creating space, plus the blood supply.  

DT - I'm always amazed how well you can explain things...... Hugs!

meny, I had my rads start at about 14 weeks after surgery. It was held up by the oncotype dx test.

I didn't ended up having chemo, but had the test come back differently and had I had chemo, at U of M, I was told, they always do that first and it may be months later before they get to rads. 

However, possibly, preferably, they want to get you through treatment as economically, time and discomfort wise, as possible  so you can get on to healing modes as soon as possible.

~~

I too appreciate all the clearly explained advice from others here. Thank you so much!

truebff, we are neighbors!  Ann Arbor is my favorite place in MI.  My new oncologist is also out of U of M.  PM me if you can share who your doc is and what your experience has been with him/her.

Thanks DT, that makes sense the way you explain it. 

Truebff- I asked why 8 weeks was the latest and was told that all of the studies for reducing reocurrence risk in DCIS  had rads 6-8 weeks out.  Longer than 8 weeks hadn't been studied so they didn't really know.  

mamaoftwo- I agree with you about the terminology.  It makes it really hard for patients who are trying to compare "apples to apples" with different surgeons.  Just asking a PS if they offer fat grafting doesn't really give us the information we need to decide who to go to.  I guess it's just all too new but they need some new verbage that's for sure.

meny, this is exactly the kind of different information out there that can drive a woman crazy because while she is trying to do the right thing, she is hearing it different everywhere. I switched to U of M Comprehensive Cancer Center to listen to the big guns on my treatment for surgery and radiation and evaluation. They told me that they prefer to schedule oncotypes , which takes about six weeks in itself, before scheduling anything, then if the score warrants it, they always do the chemo first, then the rads. There is also time, in between surgery for healing before rads. Anyway, it would be of interest who told you that information so I can take it to my MO next time I go. I'll be pretty pissed off if I had rads at 3-1/2 months after surgery if it was not going to be helpful at that point, because it was so toxic for me. I am 3 months out and still flat out poisoned and exhausted and burnt.

rk85, a neighbor?!! PM me girlfriend!

I'm hoping to change MOs -though I loved my BS- so maybe you should send me who yours is. (Mine is too old world and pushy.) Maybe we can get together when you are in town.

dt, I knew you were a teacher! What do you teach?