I’m willing to bet you a cookie that your surgeon, when speaking to you about your reconstruction options, never mentioned there was an alternative to implants and flap surgery. When I learned about this alternative I asked myself a few questions: Would I be interested if there was a procedure that had less risk of complications, did not require me to lose a key muscle group or have foreign objects implanted? Of course. What if this same alternative allowed me to regenerate breasts that had sensation rather than being numb all the time? Sign me up. What if I could create these new ta-tas using my own extra fat cells found on my hips, thighs and tummy? Bonus! A technique exists to successfully move fat from your hips and put it on your chest. Women have been asking for this for years but it never worked before now. It’s a two for one for boobies! This post is about sharing information if you are facing mastectomy. Information that might help you along your journey….you can’t make informed decisions without being fully informed.
Dr. Roger Khouri is a pioneering plastic surgeon who, early in his career, specialized in breast reconstruction using the latisimus dorsi (a back muscle). He also used implants but he was really well known for the more complicated flap procedures. However, he saw the limitations of this procedure, especially for women having received radiation. So he noodled other options. Did I mention he is a pioneer surgeon? Pioneers are thinkers. They are always thinking about how to make things better. How technology can be utilized differently to achieve an outcome. They can’t help it…it is how their brain is wired. Dr. Khouri has taken a current, well-accepted practice called autologous fat grafting and improved it in a major way. Plastic surgeons all over the country take small grafts of fat from one location on a body and inject it to other locations like the breast, buttocks and face. This is very common. The limiting factor in this process has always been the amount of fat that can be transplanted into an area. Too much moved into a tight space and the fat cells die. They get choked off by over crowding and lack of blood supply. Therefore, fat volumes large enough to fill an entire breast have been impossible up until the last ten years. Enter Dr. Roger Khouri of The Miami Breast Center located in Biscayne Bay, Florida. I had the pleasure of meeting him for my own consultation prior to my mastectomy. I don’t remember how I found his website but I’m glad I did. I spent hours scrolling through before and after pictures of his post-mastectomy reconstruction work. There were even pictures of women he repaired after they had terrible complications from previous reconstruction work. I read testimony after testimony of women who spoke about their experiences. You can read them HERE. I encourage you to visit his website and take a look, but I warn you, the photos are not for the faint of heart. Mastectomy and reconstruction are not the pictures surgeons usually put on their glossy brochures. But the improvements Dr. Khouri was able to achieve are extremely encouraging. Here is a link to Post Mastectomy Pictures. Or maybe you already have implants and are not happy with them? Check out these photos of Breast Implant Removal.
I felt strongly that I needed a consultation in Miami before I made any decisions about the options my surgeons had outlined for me here at home. This is a news clip about Dr. Khouri and one of his patients. Dr. Khouri and his team were great when I met with them. They answered all my questions, gave me encouragement and explained the process. You see, regenerating a new breast takes more time than the typical expander/implant route. In standard reconstruction an expander is placed inside your chest and slowly filled with saline to expand your skin from the inside out. In the technique used by Dr. Khouri, the tissue is expanded with an external expander. It is similar to a large bra with two big suction cups. Yes, it looks like a bra Broom Hilda might wear. Or, if you are a child of the 80’s, something Madonna wore on her Blond Ambition Tour. This tissue expander is called a BRAVA unit. I will have to wear this for ten hours a day. Every day. For twelve weeks. And that is just prior to the FIRST grafting procedure. There will be at least two and maybe three outpatient procedures total. I will wear it at night while I sleep. It will take work on my part. Weeks and weeks of work. The BRAVA will slowly expand my skin, but more importantly, it will expand the blood vessels, nerves and cellular matrix under the skin. Why is that important? Because it will be making a nice little, nutrient rich pocket for little baby fat cells to thrive. BRAVA overcomes the current limitations of autologous fat grafting….the surgeon can harvest more fat cells and graft much more than has ever been successfully done before. Using the old technique only 55% of fat cells would survive. With the BRAVA expansion an average of 82% of fat cells survive! Dr. Khouri has been performing this technique for the past ten years with great success. He even does this for standard breast augmentation. Here is a link to his latest paper published in Plastic and Reconstructive Surgery, the medical journal of the American Society of Plastic Surgeons.
Now let’s fast forward to the conversation I had with my plastic surgeon at home. I asked if he knew of Dr. Khouri’s work and he said he had heard him speak at the national meeting of plastic surgeons so he was familiar. I have to give him huge kudos, we had a candid conversation and I explained that I wanted to move forward with Dr. Khouri in Miami. He was very supportive and said he would do whatever I needed him to do during my mastectomy to leave me in the best surgical position for Dr. Khouri to do his work. That is when I handed him my iPhone. There, in all it’s naked glory, was my left breast circled with permanent green marker showing where Dr. Khouri wanted my incisions. Then I held my breath. This is where I thought my surgeon might balk. Afterall, I was telling him I didn’t want him to do my reconstruction and then I had the audacity to show him a picture of how another plastic surgeon wanted him to perform his work. My surgeon turned out to be wonderfully supportive. He just smiled and told me to bring that picture to surgery and he would leave me in a perfect position for Dr. Khouri. I could have hugged him! Instead, I encouraged him to look into the surgeon training courses that Dr. Khouri provided every month for surgeons around the world. Many women would not be able to pick up and go to Miami and someone needed to begin providing this service in our area. He indicated he would keep an open mind. He did warn me that Dr. Khouri makes money on the BRAVA system and I should be aware of that. I’m sure it was a well intended remark. I told him I was aware. What I didn’t say out loud was that every surgeon who cuts on me makes money doing it, my oncologist who prescribes my chemotherapy makes money on it, the hospital that provides my infusions makes money on me. My bills, so far, tally over $100,000. I don’t think there is a person or entity that does not make money on me. After all, cancer is very big business when you get down to it. However, I let that well intended comment slide right off because my surgeon is wonderful and I kept my eye on the prize…significantly less complications, no more implants and normal sensation after all this is done. I don’t start BRAVA expansion until June but I will be sure to provide updates along the way. Peace, Cynthia