Microfat grafting or BRAVA doctor recommendations
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Luvmy3cuties, it's a federal law. So yes, it is required that it all be covered - however, how much is covered depends on your specific plan, re: your deductible, out of pocket, and whether you stay in-network or not.
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Thanks Lorraine. I didn't get into details... just assumed it was all covered. Plus, I know Dr. Kish is out of network. Will have to ask more questions when the time comes.
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A nurse-friend of mine (not in field of onc) recommended Dr. Vinod Pathy (offices in Westbrook and Norwich, CT). Has anyone heard of him? Supposedly he does breast reconstruction w/fat grafting.
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Okay, after reading about Dr Aronowitz and his stem cell assisted fat grafting above, I have decided to do more research about this versus the Brava/Dr K method. I just called his office (Los Angeles) and had a nice chat with Phyliss, his patient coordinator, and have an appointment on Feb 2. I will keep you all posted.
The funny thing is I had heard of him through the whole Suzanne Summers thing and she just turns me off so much that I was prejudiced against him. Seriously, I think most of the Drs she works with sound like quacks, but this PS seems fine, maybe even genius with this new fg technique.
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lalisa, I too have mixed feelings about ss - but know I am peeved off by her commercializing helping women (making $$ on women's insecurities, needs, illnesses) and also by a friend who worships her and Farah F. and other cancer celebrities... (and, I know some of these stars help awareness, but others just seem to capitalize as opportunitists, and what is it about people who think stars know more than someone who's gone thrugh it who isn't famous?)
Does anyone here know if fat grafting is covered when used for helping the radiated breast recover (softness, pliability, etc.) and heal?
I have very small breasts and had a lumpectomy. I am more in need of fat grafting for getting the breast tissues healed - and, yep, about a dollop more and my breast could look like new too.
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lalisa- I have to admit I didn't give Dr. Aronowitz a second thought, for the very same reasons. Beacher's consult seems to have gone well, though. One thing I would warn about, that she discovered, is his office policy seems to be that the patient pays everything ahead of time, and then when the insurance pays, the patient is reimbursed. I have never heard of it being done this way and it doesn't seem right. I always thought they were only supposed to collect whatever part of your deductible hadn't been met, then bill the insurance company and then bill the patient for whatever wasn't covered. Dr. Khouri's office made me pay ahead of time and it was $3650. Dr. Aronowitz's office was requesting $7,000 (maybe because he was out of network for her?).
Weren't you considering Dr. Trott? Any idea what her policy is on this?
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I am still considering Dr Trott, and her office actually takes my insurance, I think it is only the Brava that is not covered. And Dr A's invoicing policies might prevent me from working with him. On the other hand, I may qualiffy for his study as it will be 5 years since my initial surgical treatment to remove the lump in July.
Really, I am collecting information about all the fg possibilities, I find it super interesting and who knows maybe I will eventially get a nice pair of breasts out of it. My husband and daughters (18 and 21) are very conservative about all this and seem to want me to just stay the way I am. I am ok with that option too, but we'll see.
One question for Dr A- it sounds like the stem cells continue to grow after they are injected, so how can you predict what size you will turn out to be? I'd like a nice predictable AA, like dancetrancer after her first fg procedure with Dr K.
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lalisa- Yeah, I think my family wishes I would leave enough alone. lol! (I keep telling 'em- it's not how they look- it's how they feel that I want to improve!) I'm not sure about the stem cells as it's so new. I've been plaguing beacher with questions since she actually had a consult with him. Sometimes I wish the doctors could just come on here and answer all our questions. I know Dr. Koplin had a link on his website to email him questions and he answered them personally. I wonder if Dr. Aronowitz has the same thing?
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robo-
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ILBoysMom, Robo47 - It looks like you are both in Chicago, too. Have you had any luck finding a doctor who does the fat grafting in IL? I had my swap over a year ago and don't have enough skin left for a nipple recon. I'd love to ditch this implant for a mini one (or maybe get rid of it entirely) and get the fat grafting done.
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I still have pain and I've developed a clicking/popping in my shoulder on my BC side. It is liveable but annoying and definitely gets worse with any amount of activity. I am actually in FL for a few months and thought about seeing Dr. Khouri but the incisiion under the arm is a sticking point for me. I'd be concerned for the LE hightened risks for an incision under the arm.
Will you have RADS as well? That can be the cause of some of the pain people experience. I had an augmentation on my right (non-BC and non-radiated side) at the same time as my recon and it feels 100% fine. I called to schedule an apt with Dr. Otto Placik in Chicago but his office kind of discouraged me. . .I think I told him who my current PS was an he was concerned about stepping on toes.
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Chicago- On the other fat graft thread, "Has anyone had micro fat grafting?", a new member mmscullen said she just got back after having done the implant swap/fat grafting with Khouri. She said she "talked him into" using her original incisions so seems he's reconsidering the armpit incision thing. Maybe he's been hearing all the complaints. Or is finally realizing the risks of LE.
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Hi! I just posted about my consult with Dr Aronowitz in the other fg thread... I forgot that this was the one where I started the convo, sorry!
Robo37, lol about the thighmaster, and you made my day with your 21 comment
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I would like to know where on the clinicaltrials.gov website Dr. Aronowitz's study is located?
I only see the Brava trial as a current trial open for paticipants.
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I live in Salt Lake City, Utah and had a PBM and intrapectoral fat grafting by Robert Ferguson, M.D. He was trained in fat grafting in his fellowship at M.D. Anderson and has been trained in Brava by Dr. Khouri.
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lizdehart- Could you explain more what is meant by intrapectoral fat grafting? Does it somehow help with the pecs? After one round of fat grafting I am still having a lot of issues with discomfort from my pecs. I hadn't heard this type of fat grafting titled this way so wondered if it is something new.
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The fat was placed in the pectoral muscle so instead of completely flat I look like I have "pecs" and the reason, as I recalI it being explained to me, that it gives the appearance of cleavage as well as a base for the next round of grafting.
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Kate, I've had 2 rounds of fg into the pecs, one at time of BMX and 2nd one 3 monthls later. It is really strange, because I can flex my breasts! They look perfectly normal when pec muscle is relaxed but when flexed, they move up a couple inches and look all tight and misshapened! I think by the time the FG is done, maybe after next round, they will only move a little and there will be enough fat so they don't get misshapen when the pec muscle is flexed. It is definately a strange sensation and sight compared to original breasts!
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If you want to see AMAZING results of fat grafting, join fatgraftpatients.com and see rk85's photos.
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I also have had fat grafting - subpectorally and intrapectorally. Dr. K does this especially if you have fat grafting at the time of MX b/c the pec muscle has it's own blood supply, and thus it serves basically as a flap type of procedure (but no need to transfer muscle or reconnect blood vessels like you do with a traditional flap). When you have fat grafting at the time of MX, you cannot use Brava afterwards (for increased blood flow) b/c you need to heal from major surgery and doing Brava would not be a smart idea (nor would it be tolerable from a pain stand point! LOL).
rk, I also have the movement of the graft when I flex my pecs - but I agree, it is less noticeable after the 2nd grafting procedure. It doesn't cause any discomfort and no one else would ever notice it (I don't think?) unless they knew to look for it. It reminds me of those who have implants who talk about the implant moving with pec muscle contraction. However, since the fat is soft (and I would assume more pliable), there is no pain associated with this, and I certainly don't feel it happening - I only notice if I'm studying it in the mirror. LOL
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@Kate - I'm pretty sure that grafting fat intra and subpectorally is "standard" with Dr. Khouri. For augmentation for someone who is as flat as I was it gives that feminine "swell"/softness to the upper and inner (cleavage area) chest. The same would be done for full Mx recon as Dancetrancer and RK85 have explained. But for those who have implants exchanged for smaller ones and grafting over them (e.g., you and Lee), I think grafting to the pecs serves multiple purposes. It provides "coverage" to the boniness of the upper chest, a place to inject the fat for upper pole fullness, and contour to the cleavage area between the breasts. However, it also increases the thickness of the pecs which is all that is between your skin and your implants. Since BRAVA is not used when implants are involved, there really is no tissue with any blood supply to inject the fat into if not the pecs.
It not only improves the appearance (covers ripples, adds contour, etc.), but provides a bit of cushioning/comfort for lack of a better word. And since pec exercises are pretty much out of the question w/implants I would think the fat would help protect and strengthen the pecs and allow them to support the implants with less damage to them (the pecs) over time.
As for any pec pain (other than a few days/weeks post op - should only feel like muscle soreness following an intense bench press routine), I can't imagine the fat would be what caused it - if anything it would help heal/strengthen the pecs. I would think more likely the pain would stem from the fact that there are still implants behind your pecs, and they are continually stretched to accommodate a foreign object never intended by nature.
@RK85 and Dancetrancer - I have weight trained since I was 19 (I'm 52 now), and have pretty well developed pecs. You guys have seen my before pics (particularly the 1999 ones). The teeny "mound" of breast that I had was nothing more than nipples sitting on my pecs. Past ultrasounds have shown that my breasts had zero fat, 1/10" of breast tissue and 3/4" of pectoral muscle. I have always been able to flex my pecs. I agree, it IS freaky looking (think male body builders to a much smaller degree) - I could even make them dance, lol! After my two surgeries w/Dr. Khouri, my pecs are certainly "thicker" (not to mention it has significantly increased my pec strength - have upped my bench press for the first time in over a decade!). If you haven't trained your pecs prior to your surgeries, it could be a strange thing to see. Mine are for sure more prominent. But as you say, when relaxed they simply look like natural breasts. For me, when flexed, they just look the way they did before...and then some!
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alexandra- I had never heard anyone refer to the fat grafting as intrapectoral fat grafting before so just wanted to see if it was different than what I had which it wasn't. I wasn't implying the fat grafting made my pecs hurt. Only that it didn't fix that particular issue. I think you're right- it is because I still have an implant under the pec.
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Kate, I had first found Dr. Khouri after reading the clinical trial, where I first heard that described:
"...After the recipient site is anesthetized, puncture sites will be made with a 14-gauge needle. A 14-gauge blunt tip cannula or similar cannula connected to a 3 ml syringe is used to gently inject small droplets distally first and then subsequently proximally as the cannula is withdrawn. Repeated passes at multiple levels in a radial fashion are performed through each of the puncture sites such that the grafts droplets are laid down in a criss-crossing pattern and at multiple planes. Avoid the glandular tissue by remaining in the subcutaneous plane and if more volume is needed and is available proceed to fill the subglandular, intramuscular and submuscular planes....."
A couple of days after my first procedure I felt like I bench pressed Arnold Schwarzenegger himself! I emailed Dr. Khouri to ask if he injected fat into and below the pecs and he replied that he did.
I wonder for you and others who have pec pain from implants, if over time the fat (and its stem cells) helps to gradually improve the pec damage and reduce the pain....? Sort of like doing the bench pressing for you since you no longer can. Much as it improves the condition of radiated skin. It will be really interesting following those of you who are in that situation.0 -
Hi Alexandra I have been having trouble logging into
" fatgraftpatients" well first of all its my fault i cannot remember my password but then had trouble trying to get a message out to send a nes one to my e-mail can you help Thanks Karin (beacher)0 -
Beacher, I just sent you another email. Second one explains what the issue probably is. Let me know if that helped.
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I really had no pec pain at all after 2nd fat grafting. First time w/ BMX was too much to know if i was feeling pec pain or MX pain. My pecs feel 'fuller" than ever before, and I never lifted weights or did push ups or anything before. So for anyone thinking about FG w/o implants, it is really an easy and painless choice! (other than normal soreness for a few weeks). Love it, love it love it.
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Liz, thanks so much for the post!! I would put my interim fg results as a little scary, and still not ready for prime time (as if!), but they are getting better and better! You are too kind.
DT and Alexandra, isn't it amazing the things we now have in common - "flex-able" khoobies!!
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Hey rk - as you know I haven't been on the boards much, but I took a peek - YAY!!!! Huge progress with the 2nd graft - so happy for you!!!!!!!
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And LOL on the "flex-able" khoobies!
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Thanks so much DT! I was really relieved to have two boobs again instead of three. The wrinkling and creasing that happens with leaving the skin is not for the weak of heart!
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