Follow my Brava and Fat Grafting Day by Day
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hopeful24 is that because if the time it takes? Or the discomfort? My PS is suggesting this for me to increase blood flow as had failed transfer last month and now left in discoloured pitted mess...
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I'm thinking of having fat grafting on my left side-the radiated side. My PS doesn't think insurance will pay for this. How did you get it covered with the insurance company?
Help!!!!
Babs
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Hopeful and Eileen,
So good to hear both sides of Brava. I would never consider TE after interviewing 5 women who had them. Not sure what if anything I will do.... None of it is easy.
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that is one thing everyone agrees on - nothing is easy. You just need to weigh it all and decide what's best for you. Even then, there will be "surprises," but at least you will be well informed.
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At this point, I could probably give you a hundred reasons why I hate brava, but these are the main ones:
Timeframe-with the surgery, recovery and surgery, you are looking at about a year. (Ispoke to one woman who took 3 years!)
Discomfort/pain-you will have virtually no time when you aren't connected to the machine whether it's after surgery or before surgery, you are nearly always in one if those modes.
Multiple surgeries-4, 6,8 or more surgeries take a major toll on your body. With each one, I have more problems with Oxygen levels and more difficulty with recovery. I don't know if any other reconstruction that requires so many surgeries.
Scarring-I find it funny that people talk about scars from flaps. Yes, you have a donor scar from flaps. From Brava/fat grafting I have more than a dozen scars on each leg, scars on my hips, backs and buttocks. The doc will be searching for more places to make holes in next surgery. The scars do fade, but you will always have these up and down your body.
Isolation-try and date or have any kind if a social life when you are in and out of surgery and hooked up to a big, noisy machine. Also, see how much even your closest friends are going to be around when you are at surgery 5,6,7... And they don't see that you are making any progress-but expecting people to stand by you.
I could go on, but these are the major things I wish someone had told me. I never would have suggested the brava.
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babs... I never had any problem getting the fat graft covered at either doctor (dr. Khouri and Dr. Saint-Cyr). I don't know of any insurance that covers the brava equipment ($1500+), but fat grafting will be covered if the doctor bills it as reconstruction after mastectomy.
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How long were you connected to the machine each day Hopeful? Presumably you cannot be connected to it during sleep? I work so its a consideration for me, and I have only had two but know what you mean about scars and even 7 months on from the first one I am still sore in some places fat was extracted on some days (not all the time).My only other option is lat dorsi and that means TE for months beforehand so it will be a year for me in any case, never did I imagine being so mutilated for 3 years, I am utterly miserable with myself as I am and after recent failure back to way before the beginning due to tissue damage........it really worries me I could get an infection again or near to the end and then lose everything. .After my last surgery I actually had a little mound but it only lasted a few days....
What antibiotics are others prescribed immediately post transfer?
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Lily--it was not easy to sleep with--but doable. Did 8 hours per nite, more for last two weeks. Not saying things are easy--but for me it was well worth it.
I do have minor soreness around my waist--but only if I put pressure on the areas for extended periods of time. This too will go away--I think it is best to try to stay positive. Knowing that things would improve did help me thru this ordeal. Hoping all works for you. Eileen
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Hi Eileen - thank you - how did you sleep with it? Did you have to fix yourself in position on your back so you could not turn over? It costs a lot and I have to pay for this and all my surgeries so am wanting to check all angles!!! I was very positive before and had hope but after the total failure last month which made me dangerously ill. I am finding it hard to see any real hope as and I am very scared of any kind of intervention now but need it more than ever as chest area near collarbone is worse than ever.......!! Which antibiotics were you given post transfer?
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I sleep with Brava - use a pillow under my knees.
Yes Brava is a major chore, but I am very happy I have an option for recon. Implants are out due to rads damage and flaps are limited to PAP or SGAP for me...I can scar pretty bad and am afraid of the possible functional problems I could develop with leg surgery (I'm a dancer)...so those aren't inviting options for me to say the least.
The scars from lipo are NOTHING like the scars I would have from a flap surgery. Nothing. No comparison!!!! Lipo scars are little holes about the size of oh not even a pencil in diameter - probably half that??? They leave little dots. Dr. Ahn tries to hide them as best she can. Inner knee, in the crease under the buttock, on the top of the buttocks but under the bathing suit line. The two that show for me are on my back along my spine, and two from previous surgeries that Dr. Khouri put right in the middle of the front of my thighs. In most people these lipo holes fade, and many of mine have, but these ones have remained red on me. I'd much rather have these than long lines of scars along the tops of my buttocks. To each his own.
For me, it is either the commitment to Brava or no recon. You do have to know what you are signing up for. It is not a walk in the park. It is a LONG process and requires much commitment.
I have not had any insurance coverage issues thus far. I had a few things denied, but the majority of my stuff has been covered. My docs either wrote off what was denied or appealed it and won. Nothing was denied because of fat grafting. It was due to "too many codes filed in one day" or codes being mutually exclusive, etc., etc. All typical insurance stuff, to my knowledge.
I was given Keflex and Clindamycin for 2 weeks post surgery. No breast infection, but lucky me got c-diff b/c the antibiotics wiped out my GI tract. Fun times! I was taking probiotics, but apparently not the right ones. I will be better prepared next time with the right probiotics.
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Lily... You're supposed to do an average of 10 hours a day, with less right after surgery and more right before. Yes, you can sleep in it at night. For me, that meant sleepless nights from this discomfort/weight/machine going on and off, but there were times I really wanted to go out during the day so I did it at night anyway. In the last eight months I have had about a dozen days total where I didn't have to wear Brava
Dancetracer... You are not being fair about Flap scars being worse than lipo ones. I have both. My flap scars consist of a line in the same place as my hysterectomy scar. It is low enough that I was wearing a bikini this summer and most of it has faded to white so you can hardly see it. The only other scar from the flap is the circle on the breast, which will be the areola. As for lipo scars, I just counted 20 spread on my legs, hips, buttocks and waist. Six of them are stitched and will be removed tomorrow. The ones that are healed I've been putting the same vitamin e and cocoa butter I have had on the DIEP scar and I'm hoping they fade at some point, but because they are all over, even fading is not going to hide them.
I am glad that BRAVA is there for those who have been radiated and don't have a choice, but there are many other options that are quicker and less painful. I keep hearing about how the BRAVA surgeries are so much shorter, but do the math on one long surgery vs. 6-10 short ones and you'll find yourself under a lot more anesthesia with just as much chance for complications, like the problems I am having.
It's a very personal choice. Feel free to keep asking questions!
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All I can say is I'm basing my statements based upon my experience, just as you are. I have seen some very long scars for leg flaps - extending out past where a bikini would cover. They say it can be hidden under the bikini (and I've seen that done beautifully, too, especially on plastic surgeon sites where they show their best cases), but I have read numerous stories and seen several pics where the scar extends above the posterior bikini line (in the case of the SGAP) or is not completely hidden in the buttock fold (PAP, IGAP). I am not talking about DIEP. I never qualified for that, so I never looked into it in detail. It may be that DIEP leaves less risk for scars showing outside the bikini than SGAP or PAP.
I also said several of my scars have stayed very red. I would rather a red dot in several places than a big red line. That is how I scar. Again, my individual case...just as in your individual case your DIEP scars healed beautifully for you. I am glad you had good results with that. If I could have done DIEP it would have been my first choice. I did not have enough fat in that region. I did not want implants and was very afraid to sacrifice my buttocks or legs due to potential for increased scarring and/or perhaps functional loss/nerve damage.
I had 12 (maybe 14?) lipo holes from my last session with Dr. Ahn - she did posterior and lateral thighs and my lower back. All but the two along my spine in the back are covered/concealed beautifully. The ones from dr. K have all healed except for two he put right in the center of my quads. Wish he hadn't done that b/c they do stick out like bug bites still, 2 years later. So ladies if you are having lipo, ask your surgeon about WHERE the entry points will be for lipo and how they will hide them discreetly, if possible.
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I agree with Hopeful that "nothing is easy" and that we each have to weigh out all the options. And like DT said, all we can each do is report our own experiences. Eventually, there will probably be more studies that reflect satisfaction percentages with AFT + Brava....if there are any out there yet....I'm sure DT would know!! She is the research queen!
I can't say I had any pain with Brava...just that it's a pain in the *** to have to wear it and yes, it does cut down on social life. I thought the pain post surgery was quite mild (not everyone agrees on this, but by day 2 I was out and about). I did it the whole process (nine months) while working full time. 8 pm to 6 am was attached to Brava. I was able to sleep pretty well...alarms once in awhile. I only had to take 3 days off work each time (most women take at least a week, but had a job that was mostly at a desk...some home visits...nothing heavy duty though). I did not have radiated skin....but never would have done the other surgeries. Would take the cons of this approach over the cons of other approaches. I don't notice any lipo scars remaining...but maybe if I searched, I would notice some. If anyone wants to see my photos they are in the photo gallery under recon after mastectomy #1 set of photos. You can see from the side view how much body sculpting he was able to do. I had just the right amount of fat.
http://www.miamibreastcenter.com/reconstruction/be...
It is hard work weighing out the options....wish all of you well in the process!!!
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Wondering if someone would please post a picture of the BRAVA machine? How does it stay in place? Can you wear it at work?
Thanks, ladies.
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Georgie,
Go to this link for a picture and brief video explanation.
http://www.miamibreastcenter.com/reconstruction/after-mastectomy-miami
You will see that it sticks out really far and is quite embarrassing to wear in public. Can be done, I've traveled with it (using a poncho over). Did even wear it to work one day (I think that must have been the medium size domes...large and XLg would be hard to pull off without feeling super self conscious) It stays in place though a mild suction from the "smart box" hooked up with some tubing. It has a silicone gel ring and you prep the skin with skin prep. There is also a "bra" that fits over everything to help keep it in place. Hope this helps. I'm sure you could also google Brava and find pictures and more info.0 -
Twelve stitches from thighs through chest removed today for 12 more lipo holes. Hopfully, many will fade, but I will probably always have to use some kind of makeup on them.
In addition to nerve pain which can last weeks (it was in my back from the hip lipo last time and under my breast this time), the multitude of fat grafting surgeries have really taken a toll on me. I ended up in the hospital three days this last time because my oxygen wouldn't come up. I still get tired and short winded just talking on the phone two weeks later and have been told by the Homecare nurse not to go out in the cold air.
I think, in the end, the toll that brava & fat grafting takes on your body over 1-2 years is what will be it's downfall. My doctors and nurses have already documented that and I will be writing about all my experiences -- and all procedures -- at some point.
All I can do right now is lie here alone everyday, doing the brava as much as possible, sitting up to work as much as possible and keep myself as healthy as possible until I can have the final surgery, dump this machine and have a life again -- one that's not filled with pain, isolation and debt.
I guess it might be different if you have a significant other/family at home, but I will never understand how anyone with a choice would put themselves through this. Even your closest friends start to disappear after a few surgeries.
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Hopeful,
My heart goes out to you. Thank you for sharing your experience because you are helping other patients know the downfalls to consider. How many surgeries have you had, and how far apart were they?
Do you work full time and at home? Take care and stay warm.
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Hi,
I'm glad I found this active thread. I had a rt lumpectomy and re-excision in Oct. 2011 followed by ACT, 25 rads, and 5 boosts. I have a small dent and pushed in nipple area where the tumor (1.9 cm) was. I was scheduled for fat transfer without Brava last Nov. but had to cancel because of back problems. Now I am considering the fat transfer again and would like to know if anyone had experience with fat transfer without Brava? If so, which PS would you recommend? Also, what PSs would you recommend in the NYC - Long Island area who do the fat transfer with Brava?
Thanks.
Susanella
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susanella - I cannot recommend more strongly Dr. Ahn in NYC. I am thrilled with her!!!!!!! I travel all the way from Alabama to have her do my surgery. You are so lucky to be local.
Fat transfer without Brava can be done but requires many more surgeries b/c you will not retain as much fat. And with a radiated breast, you REALLY need the Brava, IMO, to stretch your skin out and prepare it for fat. Dr. Ahn is a big proponent of Brava so know that if you decide to go with her.
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Can Brava be used after rads? I was lookng at their website and it said no...yet ive read posts where women have used it after rads.
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Absolutely. It is very important to use it after rads if you are going to have fat grafting type of reconstruction. It helps stretch the skin and bring blood flow to the damaged tissue.
If you are looking at the Brava website you will only see info that is for augmentation. Currently Brava is only FDA approved for that. But many plastic surgeons use it off-label for reconstruction with fat grafting, including for those who have had radiation.
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Hi Dancetrance,
Thanks for the recommendation. I actually saw Dr. Ahn before I had radiation. I didn't know she does BRAVA.
I was really impressed by her. She's not on my insurance, but I may be able to get them to cover at least part of it.
All the best,
Susanella
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She's out of network for everyone. However, some insurance plans will allow an out-of-network exception. I was fortunate that she was able to apply for this successfully with my insurance. They seem to know how to get these things approved. Good luck!
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Hopeful, for what it's worth, I'm single and had the same concerns as you--diminished social life. I imagined I'd have to be home for a 6 pm curfew every evening, but it wasn't so, I still went out to dinner, etc., and could fit in the Brava time. So I really didn't find it a problem. Certainly didn't lose any friends, and believe me, I've had my share of medical issues, not just BC and reconstruction, so if they were going to take off they'd have had plenty of chances.
I'm an avid cyclist and about 3 weeks after surgery was out riding again, so down time was minimal. And I wouldn't call my few lipo dots "scars." I probably need one more procedure but for various reasons am taking a year or so off between surgery 4 and 5, so you can always take a break, as long as you want. It's a commitment but certainly not as onerous as I believed before I started.Just FYI I rarely check this site anymore, so won't be back to answer specific questions, but did want to weigh in.
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Well, I finally found a PS where I live who works with BRAVA but he doesn't take my insurance:( his assistant called me back to say I could pay myself....LOL. I am certain I could not afford it!!!!
He primarily works with cosmetic procedures so has no great interest in working with cancer patients. I was in tears as the assistant seemed to think I should be able to pay out of pocket. I guess I will have to give up reconstruction as I see no other options that make sense.
Maybe in a few years there will be another doctor who does the procedure that will take my insurance.
I thought I could handle not having reconstruction but am not doing well. I haven't looked at my chest in over a month. It is too awful. I just wear the cami all the time and avoid showering. Ugh.
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Georgie,
My surgeon, Dr Richard Kline, Charleston, SC, is doing BRAVA. He only works with breast cancer patients. He accepts ALL insurance. His primary focus as a microsurgeon is natural breast reconstruction using DIEP, SGAP, and PAP along with fat grafting.
He can be reached for a free phone consult at The Center for Natural Breast Reconstruction at 866-374-2627
www.naturalbreastreconstruction.com
Don't give up! Good luck with your major personal decision.
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I am so sorry to hear this Georgie. Have you double triple checked your insurance to see if you could have surgery outside of your state? I know I didn't realize that I have what is called a "GAP exception" in my policy. It has allowed my Dr. (who is out of network for everyone) to be treated as "in network" on my plan. You have to establish that there is no in-network provider within 50 miles that can do the kind of reconstruction you need. Paperwork has to be filed and the doc doing it has to know how to do it all, but it may be something for you to look into.
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has anyone had fat transfer done under local anaesthesia? Its planned fir my next transfer
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Pinkheart,
Thanks for this information. Were you able to get reconstruction after your implant was removed? Appreciate the support. I live on the west coast so will look for someone out here IF I can get coverage.
Dancetrancer
I will check about the insurance. Am meeting with my surgeon this week and will see if she has any suggestions. But have already asked her for recommendations and she hasn't gotten back to me. I dread trying to deal with bureaucracy. Will have to do on a day when I feel spunky.
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Georgie,
I agree...don't give up. Sounds like this is super important to you (very normal) and somehow, if you persist, there will be a way!
Hope some of the tips on insurance help.There are some MDs on the West Coast doing fat grafting. Dr. Lauren Greenberg (Palo ALto, CA) is very good. She may know of others. Dr. Susan Trott (Beverly Hills) also trained with Dr. Khouri. I have heard Dr. Chris Nichols does some fat grafting (Tacoma, WA). Have worked with his office some and they are very nice and helpful. Have heard a few others in WA, but with mixed reviews on the results.
Keep Hope!
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