Has anyone had micro fat grafting?

re: terminology, I'm finding you should ask if they do fat grafting, or "total" fat grafting as reconstruction. The first implies FG around an implant. The second implies Brava.

I'm having to call around the different docs my insurance company says do FG, in order to make a case for using Dr. Ahn. My insurance co probably thinks I want to do FG around an implant. I find when you ask the docs about FG, they say they do it, but when you mention total FG as reconstruction, with Brava, they don't.

meny and truebff - you may want to check out this thread I just started about timing of treatments:

optimal sequence for various treatments (rads, chemo, hormonal) 

I had to wait til 20 weeks, so I understand the anxiety! HTH! 

I just read the report you linked to DT - and I won't pretend to understand most of it - but it seems it's full of contradictions.   In one study it says 6 weeks, in another 20 weeks.  Maybe I don't know how to read these reports yet but it sounds like no one really knows!  Which is what I"m beginning to suspect in general.   Here's some of it below - there's lots more.   

RT DELAY WHEN GIVEN AS SOLE MODALITY AFTER BCS OR M

As already discussed, it is well known that more than half of the patients receiving RT after BCS or M are delayed because of lack of equipment and personnel, even in developed countries [13]; the percentage can be even more substantial for countries with limited resources [9]. For the latter, question even arises as to whether there is enough availability of RT machinery for every early breast cancer patient in need. From all the previous data combined, we were able to reach the conclusion in our previous report that a delay of RT of more than 8-12 weeks after surgery adversely affects local control [5].

Although data on survival are inconclusive and not definitive, given the well-established conclusion of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG), (being that for any four local recurrences avoided, one breast cancer death is avoided), we cannot assume that any impact of a delay on RT administration on local recurrence does not affect survival [15]. Moreover, since this impact on survival is seen on data with long (15 years) follow-up and given the characteristics of the relevant studies (small studies, with short follow-up), it is evident why a detriment on survival could not be detected [15-17]. Indeed, the only direct evidence, until our previous report, existing on the impact of a delay in RT administration after BCS on survival, comes from the large evaluation of the Surveillance, Epidemiology, and End Results (SEER)-Medicare data involving almost 14,000 women [18]. In the 3% of them who received RT >3 months after surgery, survival was severely impaired (hazard ratio, 3.84).

More recent studies have been published in the last 3 years: The Florence experience study, involving almost 5,000 women and evaluating the relationship between RT delay and local recurrence, was unable to detect a surgery-RT interval that resulted in increased local recurrence [19]. Authors of the study argue that local recurrence does not depend on the delay of RT administration as much as it does depend on tumors' and patients' characteristics. They only found a statistically significant relevance between local recurrence and RT delay in patients receiving chemoT (hazard ratio, 1.59) and conclude that "waiting lists" should become "programming lists" with patients being scheduled depending on their individual and tumor characteristics and their prognostic significance.

The study by Olivotto et al. [20] has evaluated the BCS-RT interval that adversely affects local control and survival. With a total of almost 6,500 women, they were able to detect a statistically significant interval of >20 weeks after surgery that resulted in impaired local recurrence-free, distant recurrence-free, and breast cancer-specific survival. Therefore, authors of the study suggest the 20-week interval should not be overlooked, while patients should be given the time for their breast to heal and their informed decisions to be made within that interval.

Finally, the most recently published study by Punglia et al., involving >18,000 women treated with BCS and receiving no chemoT, has shown that delays of >6 weeks can be detrimental for patients in terms of a local recurrence, while there exists a continuous relationship between BCS-RT intervals and local recurrence in older women with early stage breast cancer [10].

Therefore, more recent and reliable evidence, coming within the last 3 years, pertains to the maximum acceptable surgery (mainly BCS)-RT intervals that do not jeopardize patients' local and distant control and survival. This is robust, well-conducted, and comes from large centers' data. However, results from these studies are not uniform: the 6-week to 20-week interval is far from coinciding, whereas the Florence experience does not even detect a concrete detrimental delay. However, in our mind, two messages arise from all of these data.

First, with the nonuniformity of breast cancer disease being more widely recognized, it becomes evident that studies will never coincide as long as they involve patients with various prognostic and predictive factors of the disease because, obviously, the impact of RT delay on their risk of local recurrence is not the same for every early breast cancer patient. Therefore, before we rush to convince a patient that their delay in receiving their adjuvant RT poses no risks for their health, we might as well consider the individual's and tumor's unique probability for relapse. In that direction, the sense of prognostic factors attains additional importance for departmental and health policy design, implementation, and scheduling.

Second, it is obvious from existing studies that, although a long delay of >6, 8, 12, or 20 weeks should be avoided, a minimum interval of up to 6 weeks is not harmful and, moreover, might be essential for the breast to heal and the patient to be psychologically and physically prepared for another step in her breast cancer odyssey. Therefore, with proper resource planning, timing can be an advantage instead of being a drawback; moreover, present data suggest that a multidisciplinary upfront approach is essential and that RT appointments should not be given by secretaries but instead by radiation oncologists.

hello , i wanted to ask if anyone has or know of anyone that has had a skin graft transfer( thats what im calling it not sure if thats is the medical term) ? as you know i had my fg done about 3 weeks ago feb.22nd i had my 500 cc implant removed and replaced with 250cc and fg 200cc. also on my nonmx side took out the 250cc and relocated the nipple. so my non mx side is a beauty,but i stll have the hamburger bun on mx side. It is also tight still. my ps wants to add a football shape piece of skin taken from me to add more skin ,to get the flat look out,i believe he will fg then some more. it makes sense but where he wants to take the skin from is under my armpit where i have had alot of scar tissue issues....So if anyone can let me know more about this that would be helpful thanks take care all:)

Hi Kate,  my foob never dropped and fluffed last exchange so im assuming i just am lacking skin.no way am i letting him remove anything from under my arm i too am dealing with scar tissue issues under there. He s does not want to do this for a while its kinda waiting to see what the fg does next.but no matteer what there is just not enough skin. im not sure what i will do at this point....

beacher- Sorry!  I was really hoping this surgery was going to fix everything for you.  I know how disappointing it is.  I hope things are at least somewhat better.  I wonder if the BRAVA would help with your skin issues?  I don't know much about it.  Has Dr. A ever used it in his practice do you know?  Does having the smaller implants help with some of the pain at least?  I know it did for me.  (((hugs)))

Kate, your suggestion about Brava sounds right on!  I've seen documentaries where they had to stretch skin to cover future surgeries, and they put an inflatable implant under the skin and stretch it slowly over weeks.  The skin stretches and grows to cover the implant and the surgeon has the skin he needs to do the operation!  (I saw this done for conjoined twins who were going to be separated at the skull and they needed enough skin to cover both heads once separated)

 Brava does the same thing with the constant vacuum and stretching.

Also, what about the skin they are able to grow in sheets in the lab to cover grafts for burn patients?!?  I read about this stuff but why don't they have it in use yet!

Beacher, your trouble sounds like it may be something PT could help.  Now that the clips are out, maybe you just need to have some scar tissue released, or any of the other many issues PT can help with. 

Dr Khouri initially had me buy the BRAVA to use with my implants. I used it for about a week then he had me stop. He no longer uses it in ladies with implants to my knowledge. I haven't spoken with him in a few months, so perhaps that has changed again.

I do think Kate is right. This is all new, so he tries things out. Some things work, some things don't. The axillary incisions were a HUGE mistake for me.

Kate33:

Not necessarily an experiment.  Dr. K sometimes has patients wear the Brava for very short periods of time, as little as a few days, with clear objectives in mind, such as releasing scar tissue, etc. 

No LilliM, I was an experiment I feel. Its a lot of uncharted territory. I trust Dr K though. The initial hope was to use BRAVA to create the scaffolds even with implants in place. I was to wear them for months. And Kate33, I bought 2 sets, medium and large. I have the second set still untouched in the box. That turned out to not work out for me and other women for various reasons. Implant rupture possibilities was one of them.

I do think if I called up and wanted to return the unused ones, they would accomodate me somehow. My sister lives down there and every time I throw the kids in the van to hit the beach, I try to remember to throw those in the back...but they haven't made it down there yet!

who invented the brava? and is it onlt used on bc patients?or is it used for other diffrent surgeries where people need stretching and what else does it do besides strtch?cause tissue expanders do that ? thanks

Hi All,

I've been looking into reconstruction with fat grafting and the Brava following a BMX. Does anyone know how long you have to wait post radiation to begin wearing the Brava? 

Thanks! 

Kate:  I need a Northern California PS - San Jose, Palo Alto, San Francisco - who is using Dr. Khouri's method.  Do you have one? Not for me - for a referral...

Thanks!

whippetmom- I'm not home right now but Dr Greenberg was the name that came to mind, too. I'll check my list when I get home and see if I have any other names for you.