Microfat grafting or BRAVA doctor recommendations
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Eileen - I started walking the next day and added slight lunges and squats to stretch and work my legs. I was cleared to do whatever I wanted on lower body at the post-op appointment, which was 4 days after the exchange w/fatgrafting. I was back in the gym training and working out after about 10-12 days. Dr. Khouri didn't want me doing any upper body training for 1 month - no restrictions at all after that.
lizzymack1 - In the past 5 years Dr. Khouri has moved more towards reconstruction. While this began with augmentation, it has been a natural progression and is now predominantly breast reconstruction. (And definitely where his heart is.) As far as promoting cell growth - the Brava dome expands tissue and there is a chance that remaining cancer cells could be a part of that growth, however, so far the research doesn't show any increased rate of recurrence. Hopefully with time and more research, this will be further substantiated.
Jessicav - Dr. Dan Delvecchio is a plastic surgeon in Boston who also does micro fat grafting. Whenever total breast reconstruction with micro fat grafting is mentioned, there are a handful of surgeons whose names come up as experts. Dr. Delvecchio is one of them. He has worked with Dr. Khouri and they host workshops to teach other PS. Some others are Dr. Biggs, Dr. Rigotti, Dr. Khoobehi, Dr. Coleman.......there are more, but it's early and I can't remember :-)
As far as cons of microfat grating: This is a tough one, let's see, with exchange or "step down" to a smaller implant, it would be: discomfort after surgery if major pocket work is necessary, soreness & bruising from the lipo, and the possibility of some of the fat not surviving. Remember the survival rate is dependent upon the skill and technique of the surgeon performing both the lipo & injection (true micro fat grafting is done by injecting droplet at a time vs a 'glob" of fat). For straight reconstruction (ideally with the first graft done immediately following the MX) - I would add the Brava dome wear. This requires patience and dedication but is so very important to achieve the best results. We've already discussed the usual risks involved with any surgery, but I really can't think of any other cons. I really, really don't miss the saddle bag fat that was removed to give me soft, warm breasts. So that's is a major PRO!
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leeinfl--as always--thanks so much for the response. sounds as though I need a full month before I work out with my trainer. eileen
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Eileen - for upper body, yes. Working out and exercising your lower body as much as you can will help the lipo swelling and bruising subside (and make you feel better as a whole). So.....either do lower body on your own, or have your trainer focus there for a while (your *ss will thank you, lol!) - my legs and glutes got a GREAT workout during that time :-)
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thanks leeinfl--will do as so advised. eileen
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Hi guys,
As another con...as with any surgery, there can be complications. I have developed a hematoma on my non radiated breast and am getting it treated by a surgeon in my town since Dr K is about 10 hours away. It sucks, and hurts. My skin is weird colored, creepy. Having removed the 550 implants and going to the 350 with grafting has yielded me 2 entirely different size breasts...I now need all new bras since I am so much smaller on BOTH sides and I need a prosthesis to fill the cup of the smaller breast. I either deal with it or sign up for more surgery. With what I am now learning about cancer, stemcells , surgery and inflammation...I am not opting for more surgery anytime soon. I took pictures to post on timtam's site and got so depressed I started crying and didnt post. So, time will tell.
Lee, why can you not swim? I am so sorry you lost things you love with the te's. I have had no trouble whatsoever. I routinely do 3/4 mile swims several times a week, freestyle but when I get tired I drop to breast stroke. I am actually the swimmer in a team triathlon in an open ocean swim in Key West in December, woohoo!!
I suppose its the same reason some of us get knocked out by the grafting...we are all different and have to go with what works for each of us
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Kate33 wrote:
"One thing I'm so confused about is the huge differences women seem to have with the actual lipo. Lots of bruising, very little bruising, huge amounts of drainage, very little drainage, etc. Jana had pads to catch what little oozing she had. I was sent off with nothing and ended up bleeding through the compression garment from one end of my hotel room to the other. Why is this part so different? "
KATE: I think its just a very individual thing-- some people bruise easier than others. Some will be black and blue from same procedure, others not so much. With a JP drain - some people continue to drain for two weeks or three weeks , others drainage slows down quickly and drains pulled after 1 week. Think about it some people sweat more than others too. With my first fg procedure, lipo to abdomen only while I was in recovery room one of the holes was practically gushing fluid. But by 24 to 48 hours all the holes stopped draining except for one stubborn hole that could be handled by a maxi pad inside my pants (not the compression garment). This second time, lipo to inner thighs, I never even dirtied one chux pad after I was released from surgery center. True the compression garment had some stains but I never dripped on floor, etc. ( I had a tiny trickle run down shin into my rubber flip flop.) All drainage stopped before 24 hours was up. But had plenty of swelling in my ankles for days. So it just varies from person to person and lipo site to lipo site. I don't know why you were "sent off with nothing"; they offered me chux pads at the surgery center release but I already had some in car and I had already lined my hotel bed, chair, etc with them. With respect to Jana's experience, maybe her surgeon does not use the tumescent solution when doing the lipo. I think most of the early drainage is the tumescent solution making its way down and/or out.
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Geewhiz - sorry to hear that you're having trouble, but remember PSF had quite a few issues and "detours" along the way too and look at her now. Her breasts have turned out so beautiful! It's always tough for you ladies who have to travel. Hopefully the "creepy" look is bruising and will return to normal soon. Like with PSF, it might just take another round for you to get the results you want. It's not an easy, fast road, and requires quite a bit of patience, but the prize is certainly worth it. Hang in there and let him finish what he started. As far as my swimming goes - ever since the TEs, whenever I try to do the breast stroke, my pecs just won't "give" enough for me to swim comfortably. Now I wasn't much of a swimmer anyway, but the first time I went in the pool and kicked off, I nearly drowned! I had NO idea....it's gotten much better with the revision, but still not very comfortable. Just like the upper body weight training. It's just something that I have to accept as long as there is an implant in there.
robo47 - I have always wondered about that too and hope someone can answer that. Or we will just have to wait for your experience?
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FGboard girls, isn't there someone over on our board who just had their implants removed completely with fat grafting done post??? I tried really hard to remember who it was, but the stories all mush in my brain! Am I just remembering this wrong?
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I had small implants removed 4 years ago. I had immediate recon, but my body rejected one of the implants. I then opted to remove the other. I may pursue FG with Dr Trott this year. I don't feel there is much damage to my pecs, but probably there is some. I feel strong, can lift and swim as before. It took me a while to get my yoga practice back (all those push ups!) but that is fine too.
On the right side, the side that rejected the implant, I believe my pec has atrophied. I would like to ask a Dr to confirm this. My left side is a bit uncomfortable, like maybe there are weird adhesions where the pec has re-attached to the chest wall. I can live with it. If I knew then what I know now, I would not have done the implants at all, but I really did not know how comfortable I would be being flat. So strange, but it was only when I lost one implant and experienced being flat that I became okay with it, and even that was a process- it took me a few months to adjust. If I go for the FG,I will stay very small, just a bit of padding is what I want. My chest is bony and somewhat concave and I don't like that much.
Great thread, lively and so much info! Thanks to all of you
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I had one implant removed in August but am still in the process. You are probably thinking of Becky (Binga) who just had her implants out.
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Thanks Kareenie - that's definitely who I am thinking of! Just wanted to let robo47 know there IS someone over there she can talk to - and apparently you as well - to see how it feels after implant removal. Wish I could keep everyone's stories straight!0
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Jana I know there are others who are more informed about radiated tissue and the benefits of BRAVA but I remember reading posts that said the tissue is improved over time with the BRAVA allowing for fat grafting. Before you give up please talk to those women who have had the same problem with radiated tissue and overcame it with the BRAVA. Or perhaps you could talk directly to Dr. Khouri?
Just a thought.
Although my plan is to go with the BRAVA and total fat grafting once I am finished with chemo and rads and healing I must say that I really don't have a problem with not having breasts. If, for some reason, I was unable to proceed with fat grafting I will be OK flat chested. I pop in a fake pair when I go out now if I want to fill out a shirt or dress. My old sagging breasts were starting to bug me and I used to think about having them made smaller. Well what an ironic twist of fate that I wound up way smaller - just not the way I thought I would. I guess the old saying "be careful what you wish for" is a really good warning. LOL
Kathy
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Kate - that fluid draining isnt all your body fluid, so dont panic. Its a solution and anesthetic to help with the liposuction...it just all needs to drain through the puncture holes. Its a crazy 24 hours, but its quick and done.
Dancetrancer, when I was in Key Biscayne a few weeks ago, there was another patient sitting next to me waiting for surgery, her 5th and final. She was brava only, no implants. The young nurse came in giggling about how great she looked. She still needed nipples/ areola...but she had gone with fat only and was a solid c cup, if you ask me. I asked Cindy her name, but dont remember it now. It wasnt a name I recognized.
And Robo...LOL, my initial surgeon...very well regarded at one of the top cancer centers in the country..never told me anything. I had no clue. I later learned that his colleague did a nsm AND put ports in the arm instead of the chest to minimize scarring. UGH!!!!0 -
Hi,
New to the forum - thanks for all the great tips! I also had bad necrosis after TE, had them removed, had a DIEP to fill in the gaps and implants. Now have ripply, misshapen breasts and in need of serious revisions. My PS in San Francisco, one of the best here in micro-surgery, is skeptical of the BRAVA and concerned that fat-grafting gets re-absorbed. Have tried for 5 months to talk to Dr. Khouri - even paid for a phone consult - but he is never available. Soooo, bunch of questions: 1) anyone have trouble with fat re-absorbing post graft? 2) anyone find a PS in northern california who does this?
Thanks in advance for your help! Many blessings to all.
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I'll take a stab at the pro's and con's as I see them:
Pro's
- all natural; fat goes up and down with your body weight and your foobs age naturally with you
- no need for surgery 10 or 15 yrs down the road or worry about implants leaking
- nothing placed under your pecs (except soft fat injected), so less disruption of the pec muscle and less risk of long term pain/dysfunction
- less risk of complications (like capsular contracture) if you need radiation after MX with initial fat grafting
- can help soften/heal tissues if you've already had radiation prior to fat grafting
- sensation comes back (for me, almost all back at 7 wks post except for a small spot on the left lateral breast and not 100% on the saved nipple on the R)
- good option for someone who is too thin for flap surgeries but has enought fat to be collected by liposuction (most people can qualify)
- liposuction of your fat areas creates great contouring - silver lining
- minimal scars - just lipo holes and if you have SSM, very small scars near the nipple.
- fat helps to fade the scars you may have from a traditional mastectomy
- relatively quick recovery from surgery compared to other procedures b/c less invasive (but not painfree - no recon is easy!)
Con's
- liposuction is pretty painful (to me) at least - I had the front of the legs done - OUCH! (But I'm gonna do it all again!)
- multiple procedures needed b/c only so much fat can be grafted at one time
- huge committment needed from pt to wear the Brava 10 hours a day+ for 4 wks prior to each fat grafting procedure, then wear it for ??? (not sure how long yet) post each surgery, too. Also, be prepared to deal with skin issues from the Brava. Brava wear is not for sissies! (LOL, I'm a sissy, hoping I can handle it!)
- you have to pay out of pocket for the Brava - and will need multiple sets of domes depending on how many procedures you have
- need to educate future radiologist (s) to read your mammo correct (if you need to have them) due to calc's from possible necrosis - but good radiologists SHOULD be able to read them properly, and if your PS does the injection in small aliquots, much less chance for fat necrosis
- no long-term large population studies done yet - so some unknowns still with long-term outcomes, cancer risk, etc. - so far no adverse events reported that I am aware of - but you have to be comfortable with being somewhat of a pioneer patient.
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Dancetrancer - WOW! Great job, well "stabbed"
mmscullen - Have you emailed Dr. Khouri? That is THE best way to get in touch with him and his staff. As far as fat re-absorption. Yes, with fat grafting there usually is some degree of either re-absorption or of necrosis. Traditional fat grafting survival rates are pretty low but with micro fat grafting the fat is injected droplet at a time in a larger area so it has a much better chance of surviving. Personally, my left breast did incredibly well. I would say that nothing was lost there at all. On my right (my "problem") side, I'd say I have maybe 80% retention. Not bad at all compared to traditional fat grafting and I am very happy with the results.
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Jana- So sorry to hear what your PS said. I'm surprised he's throwing this at you at this point. Like others have said, I would check into the BRAVA. From everything I've read the fat grafting seems to be the one thing that helps with radiated skin. Hope you can find someone who is willing to work with you. (((hugs)))
kareenie- Thanks for the explanation. It makes sense that we're all just different.
geewhiz- I knew what the drainage was. I just couldn't figure out why some of us barely have any and some of us (me) had like Niagara Falls dripping down our legs!
mmscullen- You may want to check out Lauren Greenberg in Palo Alto. She's the only one I know of in northern CA.
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dancetrancer- Great Pros/Cons list! Thanks for compiling that!
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Kate...I was Niagara Falls and further to that, the nigh of surgery there was this HUGE knot under the compression garment down on my leg. I was in an absolute panic, thinking "OH GREAT...a blood clot or worse!!".
I yelled for my husband who came racing in...poked at it, them reached up and removed...a wad of surgical gauze!!
It cracked me up. Scared me to death, but cracked me up!0 -
mmscullen D.r Lauren Greenberg in Palo Alto. She studied with Dr. Khouri. I spoke to her myself on the phone. She said she is doing the procedure exactly the way she was taught by Dr. K.
I was planning on her as my PS until I found that there is one in my own area in Los Angeles, Dr. Suzanne Trott in Beverly Hills.
Kathy
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geewhiz- Now that is something I would totally do! 0
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So mammograms are needed after fat graft recon? Do other types of recon- flaps, implants- need to be followed by mammograms? How often are the mams recommended? That is a con for me, more tests to worry about, argh.
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lalisa - my oncologist told me that I do NOT have to have any mammograms.
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Here's a question for you ladies that have had fat grafting. You say you get sensation back in your new breasts. Does that mean sensation like you had when you had the real things ... or do you just mean you can feel pressure/touch to some degree and you are not totally numb.
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hrf- I've only done one round so far but haven't gotten any sensation back other than the skin over the breasts is now warm and I can't feel the implants anymore. Definitely a plus but not sensation. Not sure if that would improve with future rounds of grafting or not.
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Thanks, Kate. I appreciate that information. It is helpful.
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lee, it makes sense to me that mammograms are not needed after bmx and fat grafting- the tissue that they are examining is not breast tissue. But why do some oncs ask for it? I guess they are still figuring out "best practices"? And I have def noticed that some Drs are more into testing and scans of all kinds than others.
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hrf, It's a bit of both for me. I would say normal or near normal sensation majority of my breasts (75%?) but only pressure/touch on the R nipple (L nipple gone, areola to go soon, too due to DCIS too close on path). R nipple still feels altered/partially numb. I had immediate microfat grafting, with BMX - no additional grafts yet.0
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with fat grafting, it is so much like a real breast that it is easy to forget sometimes that it isn't!
I would say my left breast has about 85 to 90% sensation compared to my right natural breast. I think if my right one wasn't there to compare, I would think it had full sensation.
robo47 So excited you have an appointment next week with Dr. K! Trusting he will ber able to help you get your life back again! Who would have thought you would have ended up so limited from what is made to sound like an simple process for reconstruction.
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Hi Ladies, i wanted to know if anyone has been able to post or pm with Itinajero? She posted back around page 6ish stating how well her mom was doing with fat grafting with Dr. Trott and i wanted to talk with her more and see how it was still going,but she is nowhere to be found for me? I am considering Dr.Trott still, but not sure with this random post ??? ANYONE KNOW?? or got suggestions??? Thanks
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