Follow my Brava and Fat Grafting Day by Day
Comments
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Dear Togetherness
I am in the UK and have been so hoping to be able to get the BRAVA bra technique but..................we don't have it in this country. No, not even if you pay for it.
Khouri is the world leader. Big bear of a man as I understand it. Go to his Miami Breast Centre website and there are a few videos that you can watch. He is big but he seems gentle. My consultant in the UK knows him and says he is completed devoted to the BRAVA bra technique and his work at the MBC; utterly single minded.
I have also read on other pages of this website forum that the centre there is a bit fuzzy and their bureaucracy may not be up to scratch. But he is the best, and he is the guy who designed the BRAVA in the first place. His timing is also relatively quick compared to what I have been offered in the UK. I think he would take about 4 months for him to sort me out whereas in the UK it would be a long, drawn out procedure which would take at least 18 months, and probably more.
For me, Khouri and his technique are the best thing around, in my opinion - but I have not had any actual experience of it, but I have done my homework on it!!!
As for financing, I think your insurance will cover it as long as you clearly state that it is for BC and do not go from the angle that it is Lipo. I believe the BMC will advise you how to word your claim to your insurance company.
Again, a totally personal opinion, but for me, the idea of the DIEP is horrendous. I have seen women who have shown off their scars, joked about how they are numb from collar bone to pubic bone and I really don't find that funny. Their bodies look, to me, like something akin to Frankenstein's patchwork dolly. It is absolutely not a procedure that I will use - even if they do call it The Gold Standard, over here. Yes it's a very clever technique, but that doesn't mean it's humane. I also would not have the vast majority of the flap techniques as the invasiveness of the technique, slicing one up like a piece of meat, fat, muscle, no, it's not for me.
If you can get any joy from the BMC I wish you the very best. I would jump at the opportunity. If you can find out how much it costs, giver or take, please let me know, otherwise I'm going to have to telephone them from here. Don't know how many hours different you are from here, and which way.
Also, Dr Christina Ahn in New York is supposed to be very good also. Trained by Khouri, and you do at least get a response if you contact them!!!
Good luck, let me know how you get on
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If you are looking for "warm & fuzzy," Dr. Khouri is not your guy. He is the doctor to go to when everyone has said they can't help you. He does a lot of experimental type things (I can't even get hospital reports from him-he doesn't take surgical notes!) that can be beneficial to women who run out of reconstruction options.
I left him the moment my original doctor was back in action (he was in an accident) and never would have gone in the first place if I knew what the experience was like. But, again, I have other options.
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I have not experienced Dr. Christina Ahn, but I can tell you I have heard nothing bad about her. Every woman I know who has used her said she is great.
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ladybird dancer i am only in Spain and BRAVA is here, you could order one and i will courier on to you, you can pay courier on delivery. My surgeon is very experienced in creating "breasts" from fat transfer, and i have a spare bedroom if you and your oh want to do surgery here, he speaks english
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Dear Lily
OMG! Amazing!!!!
It's very late at night here, so can't think clearly. I will get back to you tomorrow. Thank you so much for writing. What a fantastic website this is! Best wishes.
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"ladybird dancer i am only in Spain and BRAVA is here, you could order one
and i will courier on to you, you can pay courier on delivery. My
surgeon is very experienced in creating "breasts" from fat transfer, and
i have a spare bedroom if you and your oh want to do surgery here, he
speaks english"Warm fuzzies abound here....how very cool Lily55...you rock!!
Togetherness,
Insurance should cover AFT + BRAVA procedure for breast recon....but check it all out very carefully! It can vary state to state. We got burned in WI even though we were told it would cover. Was actually cheaper for me to travel to FLA to have it done by Dr. Khouri! Nice that you already are in FLA.It won't cover for the Brava itself though. I'm not quite sure with Dr. Ahn about insurance....also have heard wonderful things about her. Just check carefully.
Quite sure Dr. K will not do DIEP. He used to be quite an expert at flap surgeries, but felt they were so invasive....thus developed an alternative....not a simple or quick process (mostly inconvenient) but certainly less incisions and potential serious complications and very natural results. I'm so glad I had this option!!
There is a lot to weigh out. Wishing you all the best as you sort through this. Feel free to PM me if you even want to talk by phone. I'm glad to share what I know.0 -
Well finally I get some reaction from the BRAVA using the hand pump and get quite a mound but by the next day it is all flat again and shows no difference - is this normal?
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Yes. The "mound" affect is temporary, but the skin stretching is permanent. This is why the doctor will ask you to wear the BRAVA into the operating room -- so it still has that "fullness" he/she can fill with fat.
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Oh I was not asked to wear it into the Operating Theatre, (only to take the BRAVA with me) but I will do so now!! I think my skin is a lot stretchier than before and seeing something there even temporarily gives me a lift, although there is a long way to go. Thank you.
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Finally heard back from dr k office. My insurance does cover the surgeries of fat grafting but not the equipment. It seems like a several surgery process and can get very expensive. I may meet with him for a consultation since I live in Florida. That cost is 150.00. Thanks for the posts I learned a lot about the fat grafting and new what questions to ask because the office staff is not very forth coming with information. Especially when u want to use your insurance.
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Had fat transfer yesterday, have no pain at all in the areas where BRAVA already stretched me, not allowed to use it for one month now as had fat pout in to areas around the edges and up to collar bone area where I was lacking flesh too........so it definitely works even when you don´t do it for the whole ten hours - I did about four hours a day...........as I have a very reactive body I felt that was enough and my chest told me around the same time each day that it had had enough....do feel daunted at how many more there will be to go....
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i am not in USA and have to pay for everything including surgery, so know how you feel
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BRAVA has not been approved by the FDA -- and I have my doubts as to whether it should -- so no insurance is going to cover it. However, in the United States, insurance companies must pay for reconstruction so you should fight this.
Of course, if you have any deductibles or co-pays that is separate, but insurance should cover everything beyond that. BRAVA is not approved for reconstruction, but fat grafting is.
The BRAVA equipment and upkeep did cost about $2K, though. Another interesting note is that when I bought it I was looking on ebay and people were reselling sports boxes for $500+. I just sold mine and the best I could do was $200
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Does anyone know if BRAVA is ever used if one has had a skin-sparing MX i.e. when one still has the "pocket", the skin of the breast?
Is BRAVA only used if you have had everything taken away and you have been left with a "flat scar" on your rib cage?
I have e-mailed Dr K from his website three times with no reply. Does anyone have a direct e-mail for the Miami clinic that I could try?
Thanks all
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I had my reconstructed left breast removed after a staph infection. They were able to save all the skin and tuck it under. I think that is what you are referring to.
My skin was stretched out with the BRAVA from the inside until I couldn't take it anymore. I had the doctor push out skin surgically this last time and he's going to finish up doing that (without BRAVA) the next time and give me my last fat graft.
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OMG! The things us women have to go through. How awful to go through recon and then have it taken away. Poor you.
Don't quite understand what you mean by "tuck it under". Did that leave you flat or did you have, as it were, an empty pocket of skin that had previously been filled with breast tissue?
I imagine a skin-sparing MX leaves one with what might resemble a cushion cover that has had the filling taken out - this is what the Docs call the "pocket" over here. I understand the BRAVA sucks out the skin by vacuum in the place where the breast was/should be - in a rather similar way in which we grew them in the first place - of course it's painful. Ouch! But if one already has the skin which only needs filling, does the BRAVA technique also work with that?
How is skin pushed out surgically? Do you mean with a Tissue Expander or........?
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Yes, it was horrible.
I'm not sure exactly what you mean. If you have enough skin out, there is no need for BRAVA. You could fill it with fat, flap or implant. The only purpose of BRAVA is to get the skin out and prepare it for inserting the graft.
Sometimes, as in my case the second time, they aren't ready to "fill" the skin (I had to get over the deadly infection). So they tucked it inside. I was basically flat, except for this mound where the skin was inside.
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OK. Thanks. It's just that when the BRAVA is used, apparently it forms a matrix for the grafted fat to sit in, whereas if any other method is used, i.e. a tissue expander, Khouri says it just squeezes the tissue, and doesn't expand it and therefore doesn't form the matrix for the fat to sit in.
I'm not sure if I have the stamina to return time and again for fat grafts that I'm told here could take at least 18 months and probably more like two years. I just got the impression from Khouri's website that his method would be quicker........................I'm only a 32A!!!!! You wouldn't think that would be too difficult or time-consuming to fill, would you???? I wouldn't!
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in my case it definitely feels different and i have no pain where BRAVA expanded my tissue but i do have a lot of fibrosis and healthy fat stem cells help soften that apparently........its not just a question of space its how much fat your body can cope with being transplanted. I used to read posts by others referring to two tears flat etc and i would think, no way i could not cope with two years of being lopsided, yet here I am 25 months on and looking at another twelve months. If you have rads then you need to wait a year before doing any recon or that is what i was told........
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Ladybird, Khouri really said that?! The BRAVA will permanently stretch out the skin, but the "mound" is a temporary effect that you can get with a tissue expander or even during surgery (by holding the skin apart). I know he wants to sell more machines, but geez!!
Here's what my doc is doing since I can't stand the BRAVA anymore and he thinks its causing more problems than good: he's making tiny holes and then pushing out from the inside, then filling with fat. If you've ever had a laparoscopy, it's the same sort of thing. He can't just open up across the scar because when you stitch it the fat would leak back out, so you make tiny holes away from the area getting fat and do microscopic surgery through there.
Lily is correct about waiting after radiation and this is also where BRAVA is a better option, on radiated skin that you can't do a lot with. Maybe that's why it was suggested to you even though you have the skin? Are you having radiation?
As far as procedures. I started with skin and bones on the left and the final one will make 6 to a small B cup.
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I have not had surgery yet. I am trying to do my homework beforehand!
The deal I have been offered in the UK is to have a Tissue Expander at the time of MX surgery - which will be reduced by the same amount as fat is grafted in. Ultimately the TE being surgically removed.
I have never spoken to Khouri - my info is what I have gleaned from his website.
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Oh, OK. Don't go by what you read about Khouri. It's a different world in his office.
That makes more sense. Without radiation and with a skin-sparring, I would not spend the time and money on BRAVA, in my opinion. My friend did it with a tissue expander while I did BRAVA. She had much less time, much less surgery and no monetary outlay. I was ready to do the expander, but my doctor said it wasn't necessary since I had already done 4 surgeries and he could do the rest of the stretching surgically.
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i am only doing BRAVA as TE not offered pre surgery due to rads and post surgery there is not enough space for one. Given your options ladybird dancer i would go with TE, you will be done a lot faster and feel better during the process, it will also work with skin sparing.......
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Hmmmm! OK ladies. Thanks for this advice. Having been to a conference for CAM I am now totally confused as to whether I should go down the surgery line rather than continue trying to kill off this ******* cancer by alternative methods.
Lily - to say I will be done a lot faster with a TE...........well, 18 months minimum to two years, quite probably, post MX, sounds pretty damn long to me! I am also considering a TUG flap instead of fat grafting, simply because when I go through the trauma of the major surgery I would like it all to be over and done with in one fell swoop and not to drag on and on and on. I want to be rewarded from submitting my poor body this extreme treatment by being able to carry on life afterwards without constantly having to return to the hosp for years and months after the MX, constantly reminding me that I am not "normal" and quite clearly not looking and feeling normal.
I've spent three years avoiding surgery due basically to fear and terror of the process coupled with the fact that I don't really believe it will work AND I just feel that the whole process smacks of mediaeval medicine, not 21st century medicine. Surely the Docs can come up with something better than chopping our bodies up? Seems like crazy stuff to me.
Anyway, thanks again for your words of wisdom. Women are great, aren't we?
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i agree it is a long time....have you joined the photo group where you can see photos of real recons? I think that is important so you know how you will look, some recons have a lot of scars across them....
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I think I did join that group, but found it too difficult to navigate and saw very little that was pertinent.
Have just posted on the natural oestrogen thread, my findings from the conference yesterday if you'd like to see them.
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"Treating estrogen responsive cancer naturally" in the "Alternative Medicine" forum are the official titles of where I've left the info.
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I think it's good to read about procedures, but don't base everything on it.
I'm not sure what CAM is, so I can't respond to that.
Yes, TE is faster. Where did you get 18 months to 2 years? That's about right with BRAVA, but TE has cut the time to less than half that for everyone I'v known who has done it.I had a DIEP flap and would do it again in a heart beat if I could. My right breast was perfect. The left one had problems, BUT I had five previous lumpectomies in that breast and the veins were compromised. Since I have a dye allergy, they couldn't scan them in advance and went in blindly. I had two veins with clots, fat die, staph infection come in. That was no one's fault. If you have the opportunity to do a flap, consider doing it and getting it over with. The result (my right breast) is truly as natural as you can get -- with full feeling.
Most of all -- take care of your health
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CAM = Complimentary/Alternative Medicine
With full feeling?????????? !!!!!!!!!!!!!!!!!!!!!!! OMG!!!!!!!!!!! That's amazing!!!!!!!!!! I had no idea that could be possible.
Times given to me by PS :-(
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Yes, I have full feeling in my breasts. No different than before, except I don't have nipples yet!
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