Microfat grafting or BRAVA doctor recommendations
Comments
-
Kate - that's interesting you had the observation about thinner women having more pain...b/c I was guessing the same thing. I agree with your theory. I think since there is less fat between the skin and muscle, you have more potential for damage and bruising to the skin, muscle, and fascia overlying the muscle. Just my theory though - no hard scientific evidence there!
I also completely agree on the pain being so bad because these are in parts of our body that must move. Again, though, the worst of it is over in the first few days.
Length of time you are under? Well, I thought it would be 3 to 4 hours like Kate. However, I was under a FULL 6 hours each time (first time with BMX, 2nd time no BMX - just lipo and grafting). I don't know exactly why it took so long, but Dr. K did say it was going to be a bit more challenging getting fat from my legs this time, plus he did a bunch of scar release using multiple needle sticks in my breasts (rhigottomy procedure), and I had many, many, MANY little needle sticks all over my breasts where he injected the very small aliquots of fat throughout (this is required to avoid fat necrosis). It's healing and starting to look much better, but wow - it was quite a sight to see when I first took my bandages off! BTW, I'm planning on posting my pics soon on the board here so everyone can see what a full fat grafting looks like. It's just a challenge b/c I have resize them all, etc. I'll let you all know when I do get it done.
P.S. I also had inner thighs and below knee on the inside done as well (they seem to like that inside lower knee fat - went for it both times...I did read somewhere that this fat is really stable and tends to therefore withstand the harvesting and grafting best). The inner thighs definitely were a pretty sore area. My bruising was the worst on the inside of the leg from below the knee about half-way up the inner thigh. Bruising, however, does not always correlate with pain. I had very, very little bruising on my anterior thighs...yet that was definitely the most painful for me.
0 -
I am 5ft. 8 in tall and I weigh about 135lb. I don't have any fat to spare on my thighs. I have always had fat pads on my hip/back area which is where I would like to take it as I have always disliked this about my bod. I might have some on my stomach also but not a lot.
I don't want large breasts. I want to fill in the indentations from the mastectomy and maybe a small bump. If I was an A cup I would be satisfied. If I had some need for bigger boobs I could wear a padded bra.
From what I have read it would seem that I have enough to accomplish my goal.
Kathy
0 -
chatsworthgirl,
You sound like a very good candidate for fat grafting! The body sculpting to me was a wonderful silver lining...taking my heavy legs that I was always so self conscious about and slimming them down to make breasts was such a win-win.
Would definitely think you have enough fat to accomplish that....Dr. K. specializes in doing slim women and when you have a spot you want reduced and realistic expectations about outcome size of breasts...you sound like a good candidate.
dancetrancer-thanks for the research articles!
LOL about the lipo theory with the slim women having more pain...I had minimal pain...what does that say about me! Guess it validates that theory. (not that I'm that heavy...140 lbs 5 ft 7 in.) I feel for you women trying to make this decision. I'm afraid I would have been scared away by hearing all of this about lipo pain!! I do not want to diminish what anypne posts about their experience...like someone said, it is good to hear from a variety of experiences. For me, it was pretty sharp discomfort with movement...getting off and on toilet and bed for a few days, but not bad laying still and not awful pain. I truly was ready to be out and exploring by day two (love exploring new cities!). There was another woman who just had FG recon done in Utah by Dr. Ferguson who also had relatively mild pain and rapid recovery. I had FG done four times taken from all areas with similar recovery each time. My surgeries tended to be about 4 hours long. I was working full time and truly only had to take 3 working days off and was fine with that. I am probably at one end of the range...but want you to know it exists!
As others mentioned, there is going to be pain with reconstruction. I was scared of accounts I had heard about the intense pain of both flap surgery and expanders.
As far as drop dead beautiful results, Dancetrancer and another woman on the FG patients forum have the most beautiful results imaginable...very little scarring and they have natural breasts with sensation. I wouldn't think the pain issue would be a make or break unless it is a choiceincluding not having reconstruction.
I respect each one's experiences and decisions...each person needs to come to their own conclusions. Thanks for your posting Geewhiz...really love Dr. Khouri's response to tell it all!! He's got plenty of paitents, he doesn't need to drum up business.
0 -
Just chiming in with my 2 cents... I wouldn't describe the pain of flap surgery as "intense". I've had two stage 1 flap surgeries, SGAP and DIEP, and while there is much about it that's uncomfortable, I wouldn't describe the recovery as particularly painful. That first time standing up in the hospital can be a bitch, but immediately after that it gets better. I was showering, walking, getting around after the first couple of days, pretty well. I ditched the narcotics after less than a week.
Stage 2 involved some lipo on my hips and upper thighs... THAT was painful.
0 -
Thank you for replying to my post/concern. I have been researching several studies. Some appear to have more merit than others, but I find similar conclusions re: stem cells. I have an appt with a P.S. who does fat grafting. Will share my concerns with her as well and hope to feel more comfortable making an informed decision.
0 -
Jeskachi You never answered my question as to where your facts were regarding surgeons losing money with flap procedures. Now I am asking you two new questions. Perhaps you will answer these questions.
You state that you have had flap procedures. Why did you have lipo?
Why do you post on this site which is specifically for the purpose of discussing fat grafting?
Kathy
0 -
Flap surgery often has a second stage to add symmetry,to correct any scarring,etc.Women who have flap surgeries may have fat grafting to the reconstructed breast.They also may have lipo to contour the donor site.This thread was started to post doctors who do fat grafting,but at some point it took a different direction.
0 -
pandazankar Yes it took a different direction. Certain posters have negative opinions about fat grafting and have caused this shift. They don't belong here. They need to go to forums for flap procedures or implants.
This is a forum for women who are interested in fat grafting to create breasts or to improve implants and to discuss this with women who have done this or are currently doing so.
I have already researched flap and implant procedures. I don't need someone telling me about them HERE. I come here specifically to discuss fat grafting for the creation of breasts. Period.
Kathy
0 -
I read somewhere that if you get a small implant and fat graft over it that you get a pretty natural feeling breast. I am hoping this will be the case for me. I don't have enough fat to make one breast. Except after the recent mx my stomach fills rounded or full but thinks its fluid from surgery.
But....I hate the fact that the Te feels like a brick and the nerve pain is horrible. I don't know if I can wait six weeks before the implant is in. The whole procedure is horrible. If I were to do again, I am not sure I would have done the mx. I would have done a partial mx with fat grafting. Since I've been dx a few years back with RSD (PAIN SYDROME) I don't deal with nerve pain well.
My ps is supposely a miralce worker...I hope so
0 -
Thanks for all the input from people about their experiences with lipo pain. I actually feel reassured. I am thinking of starting with Dr Trott and the Brava in March after I am done with some travel for work. I will keep you posted!
0 -
chatsworth wow that was harsh ...geez i cannot believe how unsupportive some bc women can be.Its embaressing and sad. i stay on this thread for one reason to learn more about fg ,even though i have decided to go with diep ,because i cannot find a ps thats qualified with fg in my state. Alot of women may be doing the same? I have learned on here that the lipo can be painful,and yes they do fg and lipo in the 2nd stage if needed to perfect the breasts, that was good for me to know.Now are you kicking me off "YOUR" thread too?
0 -
evebarry- You can get a very natural feeling (and looking) breast with an implant and just one round of fat grafting. (Not sure if you're on the picture forum but my post FG pics are on there.) I recently had a consult with a PS in Beverly Hills, Dr. Lawrence Koplin, and he said this is actually what he prefers rather than trying to create an entire breast with fat. He said in his practice in So. Cal most of the patients he sees do not have enough fat for both breasts. As far as your TE pain- if it is nerve pain you could ask your PS to prescribe Gabapentin (brand name Neurontin) for you to take until exchange. It is specifically for nerve pain. If the pain is more muscular, from the pecs being stretched, a good muscle relaxant is Cyclobenzaprine (Flexeril). Neither of these meds are narcotic but they work really well.
Lalisa- Good luck with everything! Do keep us posted!
beacher- Sorry, but I'm going to have to agree with chatsworth. The purpose of this thread is to share information about fat grafting only- not all kinds of recon. If someone hasn't had fat grafting, isn't interested in getting fat grafting, is against fat grafting this isn't the right forum for them. This is for those that have had it and those who want to have it (or think they might) to share information both pros and cons. She wasn't saying you shouldn't be here. She was saying that those that want to put down recon with fat grafting, and talk up DIEP or other types of recon, should probably move on or start another thread somewhere else.
Actually there are two different fat grafting threads. (There's probably lots of them but these are the 2 that I know about and post on.) This one was originally started so we could list the contact information of our PS who does fat grafting as they are sometimes hard to find. It would be great if we could get back to that as I think it's a great resource. There was another thread, that was started to share information about fat grafting itself but is less active now. It is called "Has anyone had micro fat grafting?" It was started in February 2010 so has a lot of information on it. Here's a link-
http://community.breastcancer.org/forum/44/topic/747737?page=51#idx_1527
0 -
Harsh? Unsupportive? I said nothing negative about others who wish to do flap or implant procedures. However, certain posters have had very negative comments regarding fat grafting. So who is unsupportive here?
No Beacher, this is not MY thread. I am just trying to learn as much as I can about fat grafting since that is what I have chosen as my reconstruction. If I was interested in flap or implant procedures I would find the threads for those discussions. That was my suggestion to those who are so against fat grafting. Not harsh just practical.
However, from now on I will keep my thoughts to myself and I will not be commenting again so that I will not offend anyone.
Kathy
0 -
Oh my God....stop acting like little kids! This is an open forum,anyone can post what they want,where they want as long as no rules are broken.....I didn't see ANYONE post that they were anti fat grafting..just that in their opinion it can be as invasive as flap surgery..this all started after the comments about PS doing flaps so they can make money....there is probably more money to be made doing multiple fat graftings..who knows,who cares? I do not know why everyone is so defensive about fat grafting....it has its pros ,it has its cons..all types of recon do....let's not throw stones at each other, we can agree to disagree and not take it personally.....If you don't like what someone says the best thing is to just ignore it and move on.....
0 -
from a disinterested reader, can you ladies please stop the back and forth? I come here to read about FG, and when I see there's a new message under my favorite topics, I'd love to read something new, interesting or helpful about FG. Thanks for your understanding.
0 -
Women who have had DIEP or SGAP get lipo in their Stage 2, so the surgeon can smooth out areas of the donor site that look funky. I had SGAP, so my upper butt was flat. Lipo and a "lift", and things look darn good!
Some surgeons don't do aggressive lipo in subsequent stages of flap surgery. But several go all out, many times, to help achieve an overall aesthetically appealing look. It's a bonus. But I'll tell ya, my first lipo session I felt like I'd been hit by a truck! Worse than the original surgery!!!
As far as flap surgeons losing money on some patients, it's true. Look at the EOBs, the cost of the OR and equipment and extensive surgical training and compare what most insurances pay (especially government run ones like mine) and it's appallingly pawltry. AND, a handful of these surgeons don't care about that. They are doing the surgeries because they believe in them, and they want us to feel better about ourselves. They even do pro-bono work, which is virtually unheard of in the plastic surgery realm. So, yeah, they're rich docs, and good for them--they deserve it. But many times the DO lose money on the flap surgeries.
I know of one flap surgeon who has actually visited Dr. K in Miami, studied the science, watched the procedures, and decided NOT to become involved with it nor recommend it. I give that surgeon credit for keeping an open mind until confronting the actual procedure. Many would just condemn without thinking twice.
Everyone here has a favorite reconstruction process. Everyone knows someone who had problems with some type. Everyone knows success stories. I'll never do this type of fat grafting, but that doesn't mean I'm not interested in it as an option for other people. And if I have a comment, I'll make it.
0 -
Hi, I am scheduled for S-Gap surgery in March after implant surgeris and revisions. I would love to chat with you I know I am making the right decision but starting to get anxious. Thanks, Jamie
0 -
Regarding the doctor recommendations ... I recently consulted over the phone with my original PS, Dr. Adam Kolker. He put my implant in 5 years ago, and he's doing FG here in NYC. He mentioned Dr. Khouri, so he may have trained with him or at least is on board with his work. He's a great PS, very caring. He has a beautiful practice on Park Ave but does a lot of volunteer work with Smile Train. Women here in NYC may want to consider him.
Since Dr. Kolker doesn't do micro-surgery, he (and my onco) suggested I meet with with Dr. Mark Smith about the DIEP. Because of my unique situation, Smith recommended trying to FG around my implant instead. I'm also going to meet with Dr. Ahn and see what she says. I feel like I have lots of time to research this and make up my mind, meet different doctors, but since I haven't seen Dr. Kolker mentioned, I wanted to introduce his name here.
0 -
I give up, I really will never understand why this fg thread is so defenisve especially when all i have done is made postive remarks about the procedure.... really uncomfortable with the selfishness of some who do not want us here.This procedure has somethings in common with the diep they both involve fat and they both involve lipo.You are more then welcome to come to the diep 2012 im pretty sure we would not mind.You will not find me here anymore if i want to check out fg i will go to the indiviuals that are more willing to help on this thread privately. Shame on you! Thanks to Pandazankar,Dancetrance,Geewhiz,Ted Williams,Kareenie,Mandalyn for your open honest kind sharing posts, I will pm you ladies when i have questions ....
0 -
I know this isn't a forum to discuss P.Ss, but I'm planning on seeing Dr. Anya Kishinevsky to discuss my options. She informs me that she doesn't use the BRAVA, but highly experienced w/fat grafting. Seems like my case would require removing current saline implants and replace with smaller (possibly silicone), then subsequent procedures for fat transfer. I still have to research more about the risk of recurrence w/fat grafting... wish there were more studies out there, but I plan to start with replacing the implants due to severe encapsulation of my right one. Sorry for going on and on, as my reason for posting is to reach out to others that may have gone to Dr. K in Connecticut, for any feedback re: their experience with her.
0 -
Luvmy3cuties - this definitely is the place to share docs who do FG. Hopefully someone will know something about Dr K in CT. FYI, there is another fat grafting doc in Boston, Dr. Del Vecchio. I don't know anyone who has personally seen him, but I have heard he has trained with Dr. Khouri.
If you are having implants exchanged with fat grafting on top of new smaller implants, you won't need to use the Brava. Brava is only used for those who are doing full fat grafting, b/c you are transferring so much more fat and need to create a matrix for that fat. I think when you do fat grafting in combination with implants, no Brava is needed since the amount of fat grafted should be smaller and thus should survive. Those who have had implants plus grafting please correct me if I am wrong. According to some posts I've seen, Brava done over implants has resulted in problems like blisters on the skin.
0 -
Thank you dancetrancer. Boston would be a long drive for me, so if I chose BRAVA as an option, I would probably make appt with Dr. Khouri in Miami (fly there) or Dr. Christina Ahn in NY (train ride)... as both seem highly recommended by others in this area. Wish there were more P.S.s closer to me that specialize in this procedure. I've seen web-sites of other surgeons who do this, all are a distance from me, but you never know if their site is more of an 'Ad.' Hoping others on this board have used P.S.s in CT and can give recomendations. For those who have flown to see Dr. K and followed through with the surgery, do you go back to him every 3 months for the follow-up procedures... or did you complete the process with a local P.S.? Also, how long of a recovery time are you in Miami after the surgery? Will be a challenge as I have children that I need to plan child-care around. Thinking I will want my husband with me in FL during all this.
0 -
Depending on how the first surgery goes for you, you may not need follow-up procedures since you have implants to give you extra size. I'm going to defer to Kate33, though, for the full answer on this one.
I do need follow-up procedures since I am full fat-grafting. We either fly or drive (I live in Alabama, it's a long drive but doable). I would allow at least 4 days after surgery before flying home, and use a wheelchair at the airport so you don't have to stress your lipo'd legs and post-surgery tired body out in the long walks at the airport. 5 days would be preferable to me, but I might be a bit of a wuss. LOL YMMV
Oh, and yes, you will definitely need your husband or someone with you, IMO. It's not that you can't get around pretty well within a day or two, but that first 24 hours is tougher, and you will definitely want someone to take you back to the hotel after surgery. Dr. K's office does have a nurse you can hire out to stay with you the night of the surgery if you don't have someone - they won't allow you to leave post-op unless someone is with you.
0 -
For those of you sharing your PS info it would be helpful to possible future patients if you could pass on either their website or contact info. More and more of them have made it easier to find them on the web- but not all. Also, I'm trying to compile a datebase of fat grafting surgeons so if anyone wants to pass on any info I would appreciate it so much. You can either post here or PM me.
LUvmy3- I have heard great things about Dr. Kishinevsky. Like dancetrancer said, you won't need to use the BRAVA. One thing I would ask if Dr. Kishinevsky is planning on doing a round of fat grafting at the same time she does the implant swap. This is what Dr. Khouri did for me. I was able to swap my 375 implants for 225 with just one round and have been happy with that so no additonal rounds were needed.
beacher- Just wondering why you've ruled out Dr. Koplin in Beverly Hills? He has over 20 years experience with fat grafting and his website says he does fat grafting for full mastectomy reconstruction. I know you consulted with him so was just wondering why you chose not to do the fat grafting with him? Has he not done many full recons with the fat?
0 -
Hi Luvmy3... I have 3 little ones as well! I flew for pre-ops each time to see Dr K then stayed an extra week each time. He usually postops a few days after surgery, so you need to be there to get bandages off etc. My mom kept my kids the 2nd time. My sister lives on the beach a little norh of Dr K and it was wonderful to recover before going home. You will need help the first couple of days. There are lots of places to stay, apartment type things right across from the surgery center. VRBO has plenty of options and Cindy in his office stays super current with them. I know you have someone, but for ladies who don't ...she even has a lady with a duplex that will help you, do errands etc. You might even call his office, see if he has trained anyone closer to you.
0 -
Luvmy3- I think you and I were posting at the same time. Like dancetrancer said, you have to have someone with you or hire a nurse. As far as follow-up- none was required if you're just doing the implant swap/fat graft. Dr. Khouri did have me send him recent photos about a month or so out and said everything looked good. I did have some post op issues which turned out to be some scar tissue and ended up consulting with a PS here in Phoenix rather than fly back to Miami. If you end up going to Miami you may want to join the site fatgraftpatients.com. There's lot of recommendations on where to stay and how to prepare for surgery that is really helpful. Alexandra (site administrator) had recommended our hotel and it was wonderful. That site was invaluable in preparing me for everything.
0 -
I had an office consult with Dr.Kishinevsky and a phone consult with Dr.DelVecchio in 2010.I saw Dr.Loomis in MIddletown this past July 2011.Dr.Kishinevsky was going to do fat grafting for me as total recon.She spent a lot of time with me, showed me photos of her work( there were no photos of fat grafting but her results with DIEP and implants were beautiful) I had tissue expanders placed(march 28 2011) by a local PS and they were so painful for me I had to have them removed.Dr.Kishinevsky assured me she could still do the fat grafting.I then spoke with a patient her office referred me to.This woman had not had fat grafting as total recon, she had it in conjuction with DIEP.She was very pleased with her results,but I had a hard time understanding her and was never clear why with DIEP she had to have so many fat grafting sessions.I am sure by now, Dr.Kishinevsky has done total recon with fat grafting.The phone consult with Dr.DelVecchio,he did the original trial with Dr.Khouri and I believe still does the trainings and seminars with him,at least he did last year....he was adamant that he only took patients who would strictly comply with the Brava.He told me to expect multiple fat graftings and made no promises of how many I would need..he was extremely honest about what to expect in terms of possible pain from the lipo.He also insisted that we have weekly Skype conferences, he would not accept still photos for updates.I liked that he expected compliance to get the best results and insisted on the weekly Skype.I was told I might have costs upfront as he was not a provider in my insurance plan.The PS who placed my TEs attended a seminar of Dr.Khouri's,both he and Dr.DelVecchio did presentations,(the week after I had my expanders removed) he also knows both of them personally.After going to this seminar,he did not feel that fat grafting with TEs would be the best approach,he felt the Brava was needed and he felt I would be very happy with Dr.DelVecchio.His personal opinion was that Dr.Khouri was inclined to be a little too optimistic as far as number of graftings needed and that Dr.Delvecchio was inclined to say you would need more and it would turn out to be less,he felt he erred on the side of caution..While I was recovering from the TE removal(which was April 21, three weeks after they were placed with uni proph mast)I kept researching because Boston is about 7 hours from me.I found Dr.Loomis in Middletown NY who trained with Dr.Khouri and went for a consult in July.I was very impressed with him, he was kind, caring and honest.He told me he would have to do surgery to remove scar tissue and that I should expect a minimum of five graftings to get to a small B..I wanted to be at least a C.He expressed concern that with my fibromyalgia the Brava might be problematic.He had asked to have a Brava system in his office for patients to see and try but was told that he would have to purchase it,even though he was providing info for the clinical trial to get FDA approval.I was out of network for him,but he said he would accept whatever my insurance would pay him and that he would arrange for me to have a 23 hour stay at the hospital since I am close to three hours away.I wish I had found him before I had the TEs removed,I would have had him remove them and do fat grafting at that time,just so my chest would have some cushioning.He is the one who helped me realize that fat grafting was not a realistic possibility for me,the thought of spending close to $1000 on the Brava which is still in trials and the possibility that I might not be able to tolerate it plus five 3 hour (estimated time) surgeries away from home and recoveries to get a B cup was just not right for me.Dr. Loomis website is www.drloomis.com He did not have info on breast fat grafting on his website last time I looked. I also spoke with a Dr.Vega in Rochester NY,who had not done fat grafting,had no training in Dr.Khouri's method,but said he would "try" it on me.Before I spoke with him,his office wanted me to set up an in office consult,assuring me he accepted my insurance.I checked with my insurance and while he had been one of their providers a few years before, he no longer was,for reasons unknown.So I was glad I checked on that.I did not set up a consult,mainly because he was too willing to use me as a guinea pig.If anyone wants more info,they can PM me.
0 -
GeeWhiz, Kate33 and Panda..., thank you for all the info. I tried to reply to some of your PMs, but it seems I went over the amount of messages I could send/day. I plan to also see Dr. Julie Vasile in Stamford, CT. If anyone has gone to her and cares to provide their '2 cents' worth, I'm all ears
0 -
OK, my pics are now up on the picture forum for those who may be interested.
0 -
DT, what forum are you referring to? The one run by Timtam?
0
