FAQs

FAQs

-Frequently Asked Questions-

EVE

Is EVE still avaible?

My surgeon tells me that EVE is no longer available and that he can do the fat grafting without it. Is this true?

 

Answer: It is true that EVE is no longer available. But our extensive experience with this procedure has convinced us that we get the best results if we graft a pre-expanded recipient site. Without expansion, a cautious surgeon will only graft the small amount of fat the tissues can tolerate, resulting in minimal volume gain. Should your surgeon be more aggressive and graft more, there will be a lot of temporary swelling; but since most of that fat will not survive, the end result will be very poor.

 

Dr. Khouri, the inventor of EVE, still offers an external vacuum expander (EVE) to his patients. If you already have implants, your tissues are stretched. Removing your implant or replacing it with a smaller one leaves some tissue laxity that is essentially similar to the external vacuum expander effect. Therefore you might not need the external vacuum expander (EVE) if you still have implants.

 

If you need EVE, during your initial consultation, the Doctors at the Miami Breast Center will fit you with the expander, make sure you understand its use and can tolerate the required treatment.

Can I wear EVE an schedule my srugery later?

Dr. Khouri expressed a number of times that the ultimate outcome of the fat transfer process lies in the hands of the patient; those willing (and able) to put in as many hours as possible, for as long a period as possible, would reap a far better return on their investment. That being the case, can I leave the timing of surgery ‘open ended’ until I have given the EVE system sufficient time to maximize expansion and growth.

 

Answer: If you have started using the hand pump more than a couple squeezes when the pump vibrates you should stop that until you decide when you will go in for the surgery. Using EVE to obtain some permanent growth requires a different wear protocol than using EVE as a precursor for surgery We had guided you to start EVE in the non-surgical traditional manner, sport box only and you could use the hand pump just to get a quicker seal. However, you need to know that if you have been doing any cycling repetitions or pumping up with the hand pump to extreme levels, yes, you will see greater swelling but you may also see greater levels of sagging in the end if you don’t do the lipo filling surgery. Dr Khouri always says that the ultimate outcome of the fat transfer process lies in the hands of the patient; what he is referring to is using EVE’s correct protocol for the correct procedure and the intense wear and pressure is only for the Surgical route: the fat transfer. Certainly even for the Non-Surgical routine, the more you wear EVE, the better result you may achieve but that does NOT include increased pressure. Non Surgical protocol is low pressure over extended periods of time and it all depends on their circumstances as to how much permanent “gain” they may achieve.

How long do I need to wear EVE?

Answer: The day you come to see Dr. Khouri you can have your MRI done. You will then need to order the EVE system. The EVE system is worn for 3-5 weeks before the procedure. During that time you will use the EVE for about 10-12 hours a day or while you sleep. You will also need to send Dr. Khouri photos every week of your breasts to see how you’re doing in terms of expansion. On the final week or wear you will be required to wear the EVE non-stop (only taking it off to shower). We ask our patients to come into Miami 48 hours before the procedure will take place. Dr. Khouri will see you within 24 hours where he will prepare you for the procedure. On the day of the procedure you will need to go to the surgical facility wearing the EVE system and you must not take it off until Dr. Khouri takes it off of you on the surgical table. You will need to come with someone to help you after surgery or hire a private duty nurse. You will also have a post op visit with Dr. Khouri after your surgery.

If my skin is stretched, do I still need EVE?

If a patient already has stretched skin on their breasts with little to no fat tissue or have breast-fed their children, is there a chance the EVE may not be necessary?

 

Answer: Compared to the tight breasts, the stretched out breasts will expand much better and faster with EVE, thus allowing you to get a better final result. But even if your skin is previously stretched, you still do not have the internal structure/space that will allow us to successfully graft the large volume of fat required for your augmentation. Unless Dr. Khouri tells you otherwise during your office visit, you will still have to wear the EVE for the recommended time.

How much does the EVE system cost?

Answer: Cost of the EVE System varies depending if the EVE needs to be customized in case of different sized breasts. Reduced prices are available if patient schedules for fat transfer surgery. For more details on pricing please call 305-365-5595.

What is the EVE device and how does it work?

Answer: EVE is a soft, gel-like external breast tissue expander. You wear it like a bra, at night when you sleep, to gently expand the breast area. You can find out more on the EVE page of our site. EVE applies gentle, sustained tension on your breasts, which causes cells to replicate and produce new breast tissue. Not only does it expand the skin from the inside, it also has the effect of regenerating a breast through the expansion of tissues and nerves while keeping blood flow. This does two important things:

 

  • It creates an adequate matrix into which fat is later injected through liposuction.
  • It allows the patient to keep sensation in her breasts and nipples.

 

Fat is then removed from one area of the patient’s body and meticulously injected back as hundreds of tiny individual droplets at the breast site that has been enlarged by the EVE expansion.

How do I increase tension on EVE?

I already own the EVE device and I used it for 10 weeks, (I grew an inch, however the shape has not improved). I understand that I need to use it at a higher intensity for 4 weeks, is there an accessory to buy or how do I increase the tension?

 

Answer: The fact you are already familiar with EVE and you proved that you can use it effectively is a big plus. However, if you want to have fat grafting you need to come for a consultation in Miami at least 2 weeks after having discontinued EVE use. This can be a day trip during which we will arrange for you to have an MRI of the breast. This is important so we can evaluate your baseline without EVE effect. During this consultation we will evaluate your problem, explain the recommended procedure and answer all your questions. We will also teach you how to increase the tension to get the desired pre-operative expansion effect.

Breast Augmentation

Do I have enough fat?

I’m slender, 5’5″ and 118 lbs, a doctor I previously saw told me that I only had enough fat to improve the shape, but the size will be the same, I must admit that the shape is the most important thing for me, but I also would like to grow a cup size (I’m currently 32A, small B) what can I really expect?

Answer: We actually prefer you to lose weight. There is only so much fat graft volume we can put in a small breast. Since volume, not the number of cells is the limit, we prefer to put more skinny fat cells that will get plum and further enlarge your breasts once you gain your weight back than put a smaller number of plum cells that will shrink and reduce your breast size once you lose the extra weight. And of course, we will treat the constriction at the same time. Because you are relatively skinny, it will take us a little more time to harvest the fat, but we should be able to give you a B cup. Please see our full explanation on how we harvest fat from thin patients.

Breast Implant Removal

Can I switch the implants for fat grafting?

I got saline breast implants because I was very small-chested before. I want to get rid of my implants but suspect my skin has stretched greatly since the surgery. Do I sound like a candidate for your procedure?

 

Answer: Yes, you are a good candidate for our procedure. Your story is not unusual. Breast implants often feel and look fake, especially for women who had smaller chests. We can replace your implants with your own fat and make use of the tissue stretch caused by the implants to get a greater amount of fat in.

Do I still need EVE if I have implants?

I’ve had implants for about 10 years. I would like to have them taken out and possibly have fat transferred in. Would I still need to use the EVE system? I’ve read that fat is transferred a little at a time. Can that be done in one operation, or does it require several operations a little at a time?

Answer: Yes, we can help you replace your old implants with your own fat tissue. At the time of implant removal we can graft some liposuctioned fat in the stretched out breast tissue. This will give you some augmentation, but not quite as large as what you had with the implant (about 50%). That is, assuming we remove 400 ml implants, we can give you back about 200 ml of natural augmentation in one small out patient procedure. This step will not require EVE. Should you still want to be larger, you will need to wear EVE 3-4 weeks post-op and then get a second fat grafting procedure that could, if you desire, make you even larger than your implanted size.

I have capsular contracture, am I a candidate for fat transfer?

I had breast implants put in several years ago and I’m not happy with the results. They look great but are hard. I have silicone implants. I scar easily, and have loose skin and stretch marks on my lower body (where I would want the fat removed). My implants are 360cc. Am I candidate for your fat grafting procedure? I bleed/bruise extremely easily…even with acupuncture…after the implants my breast were black and swollen for weeks and fluid was draining to my hips. If so…what are the side effects?

 

Answer: Yes, we can help you replace your contracted scarred implants with your own fat harvested from your abdomen. Would recommend you send us photos of your torso and abdomen so we can better evaluate you and/or wherever you have extra fat to determine what can be done. Take a frontal view from chin to pubis and two obliques and two lateral views. The fat grafting procedure if well done has no significant side effects. That you bleed easily should not be a problem since we will not be doing any cutting except what is needed to remove the implants. This is considered minor surgery with rapid recuperation. For more information on cost please visit the insurance.

Breast Lift

Who is the ideal candidate for breast lift fat transfer?

Answer: Any woman who wants to restore her youthful appearance whether she lost it due to child birth, weight gain, or just plain gravity.

Breast lift on tubular deformity?

Is Dr. Khouri able to do breast lifts for tubular deformity while fat grafting? Are the results permanent from the surgery? If weight is lost then will there be loss in the breast as well? Recovery time after surgery?

 

Answer: Yes, we have the very best procedure for the treatment of tubular breast deformities. We improve the contour, enlarge and lift the breast without any incision or scar through fat grafting after you have used the EVE device for a month or so. Dr. Khouri has the largest experience in the U.S. with fat grafting the breast and has presented large clinical experiences at many national & international plastic surgery meetings.

 

Our results are permanent. What you end up within your breasts is your own fat. It is live tissue that will fluctuate with your body weight. Like any woman with natural breasts, they will enlarge as you gain weight and decrease as you lose it. However, since after the liposuction, a lot of your body fat will reside in your breasts (having removed it from its normal sites), gaining weight will preferentially enlarge your breast which will be the only remaining depot for the fat.

Chemotherapy

Can I be taking Tamoxifen?

Answer: Any woman who wants to restore her youthful appearance whether she lost it due to child birth, weight gain, or just plain gravity.

Can I start reconstruction while on Chemotheraphy?

Can I start the breast reconstruction process while still undergoing Chemotherapy?

Answer: Yes you can from a reconstructive surgery standpoint. However, your oncologist must agree that you are fit for surgery.

I had chemotheraphy & Herceptin, can I do breast reconstruction with fat?

After my mastectomy I had chemotherapy as well as Herceptin. Is it still possible to do breast reconstruction and fat grafting?

Answer: Yes, after chemotherapy you are certainly able to have your breast reconstructed with fat grafting. However, we prefer that you complete your Herceptin treatment before the procedure.

Fat Transfer

What happens to the skin after liposuction?

What happens to the skin after you have taken the fat out? Does it tighten back up with exercise?

 

Answer: With our technique of liposuction, the liposuctioned donor sites often end up giving the patient additional cosmetic improvements such as narrower waistline and larger buttock cheeks. We sometimes can tighten the skin, but we rarely end up with loose skin at the liposuctioned sites. If you ever end up with loose skin, more than exercise, a therapeutic massage program might help.

Are the fat injections don only during a liposuction operation?

Answer: Yes, fat injections are done at the same time as liposuction. We do not store the liposuctioned fat, we inject it fresh. Our liposuction method is very gentle and we harvest the fat diffusely with very fine needles that leave a smooth improved contour with very little chances of irregularities.

Do you offer stem cell grafting?

I heard about stem cell grafting and PRP treatments. Do you offer this kind of treatment at the Miami Breast Center?

 

Answer: There is a lot of media hype around stem cells and a number of other additives touted to improve the results of fat grafting. Unfortunately, these are all marketing hypes with limited science backing. Although in the lab, on rats, stem cells and other additives might enhance the survival of fat grafts, none of the carefully controlled studies in patients have shown that any of these additives provide a significant beneficial effect compared to simple fat grafting. As a matter of fact, the FDA is clamping down on these so-called “Stem Cell Centers”. Doctor Khouri is a recognized international expert and opinion leader on that subject. He is a member of the Stem Cell Task Force, he has published extensively on this subject in peer reviewed scientific medical journals and was recently asked by the American Society of Plastic Surgeons to write an authoritative review on that matter in Plastic and Reconstructive Surgery, the Official Journal of the Society.

 

To reconstruct a breast we need large volumes of fat to survive. The limitation of large volume fat grafting is a recipient large enough to accept this large graft volume. It is a recipient site limitation; the quality of the fat is not much of a rate-limiting factor in the clinical applications. At the Miami Breast Center, we shun away from this hype meant to fool the gullible. We espouse the guidelines of the FDA and graft back unprocessed, and intact the fat we harvest by simple gentle syringe liposuction. Our results speak for themselves.

Hor much body fat do I need?

Does the patient have to have a specific amount of body fat? I am relatively slender but have some spare fat?

 

Answer: We can get excellent results even in slender women. However, if you have some spare fat in specific areas, this procedure will have double benefits: get rid of the excess fat and enlarge your breasts.

What percentage of that survives?

What percentage of the fat transfer to the breast survives after the procedure at the Miami Breast Center?

 

Answer: Most lay people and most plastic surgeons still rate the fat grafting procedure by the percentage of fat graft that survives the transfer. Unfortunately how much of the grafted fat remains viable, or the percentage graft survival is not a very relevant measure of success. Since the goal is to enlarge the mastectomy defect in order to grow a new breast mound, the more relevant yardstick of success is percentage augmentation of the grafted site. And it is the relative augmentation, not the absolute number that matters. Because 200ml volume gain in a 400ml recipient, a 50% augmentation, is not the same as 200ml in a 50ml mastectomy defect site, a much more difficult to achieve 400% augmentation. It is the percentage augmentation per grafting session what ultimately counts, regardless of the amount of fat injected. Experience shows that even in the best hands and with the best techniques, that percentage is rarely above 50%. It is only after we significantly enlarge the recipient site by external vacuum expansion (EVE) that we can reach the doubling effect (100%). This is what we will strive for each of your grafting sessions at the Miami Breast Center.

What liposuction technique do you use?

What kind of liposuction is used to harvest the fat and does this technique benefit the recipient from stem cell growth?

 

Answer: We use a manual gentle liposuction with very fine needle-like cannuals. Yes, we do harvest a lot of stem cells in the process and we make sure they are preserved in the transfer. However, we do not add anything artificial nor do we biologically manipulate the harvested fat.

How long does the grafted fat last?

I have read mixed reports about how long does fat survive when transferred to the breast. Can you please help me understand the truth?

 

Answer: If the transferred fat has restored its blood supply and became viable again in its new environment it will last as long as you do. Like the skin grafts applied on burns or wounds, if the skin graft takes, it stays there forever. Unfortunately, many surgeons pump inside the breast large amounts of fat that fail to ultimately survive. The body will gradually re-absorb over time this dead fat and the final result ends up very poor. At the Miami Breast Center we do our best to avoid over-grafting. We match the graft amount to the recipient capacity and avoid injecting too much graft that fails to survive. What you see at about 3 months after grafting, once the edema of surgery has subsided, is more than 95% permanent. However, since this transferred fat is live and metabolically active tissue, it might increase in size if you gain weight and decrease if you loose the weight.

General Breast Reconstruction

How loong after breast reconstruction surgery can I return to my regular activities?

Answer: Most patients are able to fly back home 3-4 days after each procedure— and return to a desk job within a week. However, after some of the more elaborate stages, it may take a few weeks till you can return to playing golf or tennis. Of all the breast reconstruction alternatives, fat grafting gives the best possible result. You will regenerate in-situ a new breast that feels and looks very much like the normal breast you lost. And that breast will recover near normal sensation! However, this is still plastic surgery, not magic surgery; we do not perform miracles. Growing back a new breast is a process that will require a few staged procedures over the span of a few months. While there will be no incisions, no cutting, (unless we need to remove your implants) some of the stages might be a bit more elaborate than others.

How involved is the breast reconstruction surgery an how long do the operations take?

Answer: Depending on how easy it will be to harvest the fat and whether we need to do additional maneuvers (such as reposition you during the surgery, release scars, remove and replace implants, operate on both breasts), the procedure will take anywhere between 2 – 5 hours. Unless we have to remove your implant, the surgery will be done without any incision. No cutting, we will not use a scalpel. The entire procedure is done with needles, syringes, and fine cannulas the size of an intravenous catheter. However, this is still an operation and we strive for safety and perfection, not speed.

Can you get good breast reconstruction results without expansion?

Answer: No. Simply put, fat is not an expander. Just injecting fat cannot significantly stretch the tight mastectomy tissues. to give you a nice breast mound. We cannot expect the injected graft to significantly enlarge the tissues and at the same time acquire the blood supply required for its survival. If we pack it too tightly it will choke and not survive. The best chance of getting it to survive is to sprinkle a fine mist of fat droplets inside a recipient site that has already been expanded. The fat will then passively occupy the edema space created by expansion. Best grafting results are achieved when we expand the recipient to accept the larger graft amounts.

Can breast reconstruction with fat work even if I´m concave?

Answer: Yes. Fat grafting after EVE treatment will change the concavity into a convexity and will allow us to gradually build up a nice, aesthetically pleasing natural breast mound. This is what we do everyday at the Miami Breast Center.

Can breast reconstruction with fat be done after a skin sparing mastectomy or lumpectomy?

have been reading your website about breast reconstruction after surgery using autologous fat. I would like to know the eligibility of a patient for receiving this treatment. In other words, can this be done after a skin sparing mastectomy, or only a lumpectomy?

 

Answer: Yes, our procedure provides the best reconstruction after both: skin sparing mastectomy and lumpectomy. It works extremely well after lumpectomy, and it will help treat the radiation damage your might have developed after the lumpectomy. Radiation causes changes to you skin (pain, redness, increased pigmentation, fibrosis, etc.). These can be reversed using fat grafting. We will therefore treat both the breast deformity as well as the secondary effects of radiation on your tissues.

General Out of Town

Where can I stay?

Are there hotels close to the hospital where I will be having my surgery?

 

Answer: Yes, please look at the Hotel Section of the FAQs.

Do you offer private duty nurse?

Will I be able to hire a private duty nurse if I cannot bring someone with me to Florida?

 

Answer: Darlene, the EVE coach, is able to assist Dr. Khouri’s patients after surgery as well as arrange for a private duty nurse if she is unavailable.

How long sholud I plan to stay?

I am from out of town, when do I need to arrive in Miami for the surgery and how long should I plan to stay in Miami?

 

Answer: The Miami Breast Center is a recognized major referral center for breast reconstruction. Most of our patients do not live in Miami and come to us from all over the World. Many come from Europe and some from as far as `China, Russia, Israel and the Arabic Peninsula. Therefore, like most of our patients, if you do not have a place to stay in Miami, we will help you make arrangements with facilities nearby who cater to our patients. Typically, we prefer that you come to Miami the day before your surgery and to meet again with our doctors on the eve of surgery. During this pre-operative visit Dr. Khouri or one of the other doctors at The Miami Breast Center, will spend a lot of time with you planning the operation in detail. He will go over the operative plan and answer any questions you might still have. He will decide with you where the fat will be taken from and, using a magic marker, he will make a blueprint and design the operation on your body. The next day you will come to our fully accredited surgery center where we have safely performed over 2500 fat grafting procedures. You will spend the day at the center and leave when fully recovered from anesthesia. We recommend you come with someone who can take care of you during the first post-operative days. We also can help you get a nurse who is very familiar with our surgery and who can stay with you in the first 24-48 hours after surgery. If, for example, your surgery is scheduled on a Thursday, you will need to come to Miami on Wednesday afternoon, have the surgery the next day, recuperate in the hotel over the weekend and return for your post operative visit on Monday morning. On that day we will spend some time together teaching you the post operative care of the breast. We might give you a breast brace to apply or teach you to use the external vacuum expander (EVE) so that you maintain as much as possible the volume gained by the grafting procedure. You should plan to leave Miami either Monday late in the afternoon or preferably on Tuesday. Short answer, you should plan to stay in Miami 5-6 days.

How far away is the hospital and airport?

Answer: Miami International Airport (MIA) is approximately 20 – 30 minutes away from all hospitals and hotels. Fort Lauderdale International Airport (FLL) is approximately 45 – 60 mins away. Both airports are great options to visit our center and close to major highways for ease of travel.

General Procedure

Are there a certain number of office visits?

Answer: For local and out of town patients, you will be required a total of 3 office visits. Initial visit: You come in the morning and depart in the evening. During this visit, we fully evaluate you, answer all your questions, get the baseline MRI of the breasts and get you fitted with the EVE. The MRI can be done the same day or if you’re from out of town can have it done at a local MRI center. Second Visit: After 4 weeks of EVE wear, you will have an office visit with Dr. Khouri the day before your surgery, You will also have a post-operative visit. Last visit: 5-6 months after your procedure you will need to return to have your last MRI done (requirement).

How long will I be in surgery and in the hospital?

Answer: Surgery time varies by case. However, most procedures are outpatient and they take between 2-3 hours on average. After being admitted on the morning of your surgery, you should expect to go home the same day.

Will I need and MIRI Mammogram or bloodwork before?

Will I need to have an MRI and/or mammogram before coming in town to have my surgery? What about bloodwork and any other test required before surgery?

 

Answer: Yes. Dr. Khouri requires all his patients to have an MRI performed before surgery. This can be done once you are here in Miami, or you may have it in your home town. However, results of the MRI should be given on a CD to you so you can bring to Miami along with the written report prior to surgery. In some cases a mammogram will also be ordered. Most out-of-town patients may have their primary care doctor order their pre-op testing. The patient should provide our staff with their doctor’s name, number, and fax so an order can be sent. All pre-op testing results should be performed no sooner than 10 days prior to surgery, and results need to be faxed to Dr. Khouri before surgery.

What happens during my initial in person consultation?

Answer: During your first consultation we will discuss your procedure and expectations, review your medical history and current health, and then make an assessment of what procedure is the correct one for you. This is a good time to ask specific questions about the procedure so that you are fully prepared, mentally and emotionally, for surgery. We will walk you through the information and provide additional information. If desired we can plan to meet a second time prior to surgery to address any other questions or concerns you may have regarding the procedure.

How long will I be in surgery and in the hospital?

Answer: Surgery time varies by case. However, most procedures are outpatient and they take between 2-3 hours on average. After being admitted on the morning of your surgery, you should expect to go home the same day.

Will I need an MIRI Mammogram or bloodwork before?

Will I need to have an MRI and/or mammogram before coming in town to have my surgery? What about bloodwork and any other test required before surgery?

 

Answer: Yes. Dr. Khouri requires all his patients to have an MRI performed before surgery. This can be done once you are here in Miami, or you may have it in your home town. However, results of the MRI should be given on a CD to you so you can bring to Miami along with the written report prior to surgery. In some cases a mammogram will also be ordered. Most out-of-town patients may have their primary care doctor order their pre-op testing. The patient should provide our staff with their doctor’s name, number, and fax so an order can be sent. All pre-op testing results should be performed no sooner than 10 days prior to surgery, and results need to be faxed to Dr. Khouri before surgery.

What happens during my initial in-person consultation?

Answer: During your first consultation we will discuss your procedure and expectations, review your medical history and current health, and then make an assessment of what procedure is the correct one for you. This is a good time to ask specific questions about the procedure so that you are fully prepared, mentally and emotionally, for surgery. We will walk you through the information and provide additional information. If desired we can plan to meet a second time prior to surgery to address any other questions or concerns you may have regarding the procedure.

Can my breasts sag with time after surgery?

Answer: Breast sagging is an effect of gravity and ideally you should wear supportive bras that help reduce the gravitational pull on your breast. That question needs to be answered individually. Whether your breasts sag again also depends on many variables including the size of your breasts, whether you go through childbirth after the surgery, etc. During your consultation you should discuss this with Dr. Khouri.

How long will it take to recover from my surgery?

Answer: Generally, post-operative instructions call for rest and limited activity in order to speed up the healing process and recovery time. For the most part you will be encouraged to walk but to avoid more strenuous activities such as running, aerobics, and weight lifting. The length of recovery varies with each procedure, and is different for each individual. Some patients bruise more than others, and most swelling is gone in a matter of weeks. If you follow our post-operative instructions carefully, you could be back at desk work within 1-2 weeks, while a full recovery can be expected in 3 months. Incisions are strategically placed to minimize visibility, and scars will fade over time but are permanent. When you come in for your consultation we will discuss your expected recovery period and any post-operative instructions in detail.

Is the fat grafting procedure done under general anesthesia?

Answer: It is your choice. But your safety and your comfort are our foremost concerns. Fat grafting requires a very low amount of anesthesia, not the same depth of anesthesia as flap surgery or any other major operation. Therefore you will be under a very light level of anesthesia and you will be basically breathing on your own. But the anesthesiologists like to maintain control of your airway with a tube so that if you are too sedated to remember to breathe they can give you a couple of breaths. We have excellent Board-Certified anesthesiologists who will evaluate you prior to surgery, explain the anesthesia options, and help you decide. If you are over 40, or if you have any medical condition (such a high blood pressure or diabetes), you will need to get from your doctor at home a medical clearance for anesthesia.

Insurance

How do I know how much is covered?

Answer: Our staff will work with your insurance company to get you the most coverage possible.

Does insurance cover reconstruction for a lumpectomy or mastectomy?

Answer: Yes, most insurance companies cover for both procedures. Verify your reconstruction insurance benefits.

Do you accept Medicaid?

Answer: Unfortunately, we’re not able to do that.

Does the Miami Breast Center offer financing?

Answer: Yes, we offer financing via Care Credit.

Will insurance cover the fat grafting procedure?

Answer: If you are a breast cancer reconstruction patient, by law, insurance covers your procedure.

Will insurance cover both breasts?

Will insurance cover both breasts if the patient is looking for symmetry or augmentation along with the reconstruction?

 

Answer: Yes, if your lumpectomy or mastectomy was done to treat cancer, all insurances cover breasts restoration and procedures on the other breast to achieve symmetry.

Mastectomy Reconstruction

On u Unilateral MAstectomy, will you try to match my normal breast?

Answer: Yes. This is our goal. With fat grafting, we are uniquely poised to sculpt the reconstructed breast and match it with your normal breast. Unless you specifically ask us to modify the normal breast (breast matching procedures are covered by insurance), we prefer to leave the normal breast alone and strive to regenerate a new breast that best matches it

What breast size be achieved?

How large of a breast can be created with this technique in a woman who has undergone a mastectomy?

 

Answer: We have reconstructed many D Cup breasts after complete mastectomies. You can see in our photo gallery some D Cup results. With our procedure, you get a stepwise increase in breast size after each grafting session. Typically, if you had no radiation, after 3 successive grafting sessions 3 months apart you can get a breast that is in harmony with your body size. If you are satisfied with smaller, we can stop after the second session, if you want larger we graft more. We stop when you are happy with the size.

Is breast reconstruction with fat an alternative to implants?

I’m a 63-year-old with bilateral breast cancer. I am scheduled for bilateral, hopefully ‘simple’, mastectomy in two weeks. My team has proposed putting in expanders, with implants to follow in the future. I am not thrilled with the prospect of having even further damage done to my body, just to pretend that I have breasts again. I’m also concerned about having implants that might rupture while I scuba dive or “just because”. The alternative presented on your site is very appealing. Please give me some realistic hope that I have an alternative.

 

Answer: Yes, we can help you restore your breasts without any implants and without any major surgery. Our procedure is much more patient-friendly than any of the other procedures. The results are a better reconstruction and a breast that feels like your own. Patients also keep most of the normal sensation in their breasts. This is truly breakthrough. Will be glad to see you in consultation at the Miami Breast Center to evaluate your situation and answer all your questions.

Prophylactic Mastectomy

I had both breasts removed am I a candidate?

I recently had a bilateral mastectomy and do not want to have implants. I have heard many people can reject having an implant and I am afraid of having them rupture. Is it possible to still achieve the desired cup size even after having radiation therapy?

 

Answer: Yes, patients who have a prophylactic mastectomy will have their best breast reconstruction done with fat grafting and external vacuum expansion.

Can I still achieved the desired cup size?

Will I still be able to achieve the desired cup size with fat grafting after I have a prophylactic mastectomy?

 

Answer: Yes, you choose the desired size best for you. This might take additional grafting sessions but we can get you there if you wish.

Do you also perform prophylactic mastectomy?

I am considering having a prophylactic mastectomy, can you perform the mastectomy and the immediate reconstruction with fat grafting at the Miami Breast Center?

 

Answer: Breast reconstruction with fat grafting and EVE is ideal for women who wish to have a prophylactic mastectomy. At the Miami Breast Center we have performed over 100 prophylactic mastectomies with immediate fat graft reconstruction. At the time of the mastectomy we are able to place enough graft to give the patient a small “social breast”, or cleavage in the upper pole. Then 2-3 months later, once the mastectomy has healed, we apply the EVE for a couple of weeks to enlarge the recipient and stretch the skin. This creates a scaffold and the envelope for the first grafting session. Then, if the patient wants a larger breast, three months later we expand and graft again. After this second grafting session most women end up with a breast just like the original one. A breast made out of transferred fat only and devoid of the breast tissue that might become cancerous. Most impressively, the spared nipple regains near normal sensation.

Radiation

Can radiated breast be reconstructed?

I’ve heard from traditional plastic surgeons that a radiated breast is difficult to reconstruct. How does your procedure differ?

 

Answer: It is true that radiation makes the reconstruction much more difficult. Implants do not do well inside radiated tissue and even flap surgery is more prone to complications. However, fat grafting can reverse that damaging effect of radiation. But this is still not a panacea. It takes a few successive fat-grafting sessions to bring back the tissues to their non-radiated state. Our method of fat grafting, together with the use of the external vacuum expander EVE, has proven to be uniquely successful in reconstructing radiated mastectomy and lumpectomy defects. The results are as close to perfect as possible. But you should be warned that the reconstruction would require a succession of grafting procedures, rarely less than 5 sessions over the course of one year.

After radiation how long should I wait for reconstruction with you?

After my radiation treatment, should I wait a year for my reconstruction with you?

 

Answer: There is NO reason to wait for a year before having breast reconstruction. For best results we encourage you to start the reconstruction immediately after radiation is completed. Radiation disrupts the DNA of cancer cells and its therapeutic effect on killing cancer is immediate. However, radiation treatment also causes a lot of inflammation. The result of inflammation is scar tissue that becomes abnormally stiff. Our experience confirms the theory and the published literature that bringing in healthy fat graft will soothe the radiation burn and damage. The newly interposed healthy fat will soften the hard fibrous scar tissue. We therefore encourage you to have the first stage of your breast reconstruction immediately after you complete your radiation treatment and before the fibrosis sets in.

Does fat transfer survive on radiated tissue?

Answer: Yes. It’s more challenging and will require more procedures but we regularly work with radiated tissue. As a matter of fact, fat grafting is known to reverse the deleterious effects of radiation.

Reconstruction After Failure

Breast reconstruction with fat after a failed flap?

I had a skin sparing mastectomy and used muscle from my back and an implant for reconstruction. Would I still be a candidate for your reconstruction with fat procedure? I don’t like the feel of the implant. It is very hard and round.

 

Answer: Yes, you are still a good candidate for our technique of fat graft reconstruction. A good number of our patients come to us for this very same reason and we replace the implant with fat to restore a more normal feel and look.

Can you correct dent on breast with fat?

I had a double mastectomy earlier this year with immediate reconstruction. I have Mentor smooth silicone implants. However, one of my breasts has a dent due to very minimal fat. This is especially noticeable when I lay down. Does this sound like something that fat grafting could correct?

 

Answer: Yes, this is something we have a lot of experience correcting with fat grafting. Our fat grafting procedure will improve your breast deformity and give you more natural, softer, warmer and bouncier breasts. But, since the thin tissues can only be doubled in thickness after each grafting session, you should realize from the outset that this might require more than one grafting procedure. And if you were radiated, to get there you might require at least 4 grafting sessions.

Can this procedure still be don if I've had prior reconstructions that failed?

I had breast cancer 9 years ago 34 years of age. I had a lumpectomy & radiation. In 2009, it returned in one lymph node. I have completed chemo, but reconstruction attempts with an implant have failed. I have a tissue expander in again – very thin, radiated skin. I feel mutilated. Your new procedure sounds like it could be a last hope for me. I just had the implant removed & expander put back in. Can you help me?

 

Answer: While our procedure should be a first choice alternative, unfortunately for many patients we are the last resort after all else has failed. They learned about fat grafting too late and wished they had it done from the start. It is truly unfortunate that our technique, although proven safe and effective, is still not available everywhere. Plastic surgeons offer their patients the technique they are most familiar with. And total breast reconstruction with fat grafting is not something most plastic surgeons have mastered yet. The majority of patients at the Miami Breast Center come to us because other methods have failed. We have extensive experience with this unfortunate situation and we have refined the techniques to salvage these reconstructions. We will not use foreign objects, only your own autologous fat, which the body will not reject. We will do a little at a time, as much as your body will allow, and build upon that. If you were reconstructed with implants, each grafting session will consist of replacing your implants with new ones half their size while we take advantage of the resultant tissue laxity to double the thickness of your tissue. Therefore, our goal at each of the procedures is to half the amount of silicone while doubling the amount of your own tissues around the implant. This might slightly reduce your implant breast size but will give you softer, warmer, bouncier and more natural breasts. We proceed with successive procedures 3 months apart till you end up with new breasts that are all fat and no silicone. If along the way, if you do not mind a small implant deeply hidden under lots of fat, we stop the reconstruction. If, on the other hand you want to be even larger, we proceed with still another grafting session.

I have thin skin, can you still help?

Am I a candidate even if I have very little skin left (thin skin), significant scarring, and deformity including from prior reconstruction procedures?

 

Answer: Yes. We routinely help women with problems such as yours. Fat grafting alone might not be enough. You might need to use the external vacuum expander (EVE) to loosen the scar and expand the tight skin envelope.

Tuberous Breast Deformity

Can you correct tubular breast and do an augmentation?

My right breast is minimally tubular shaped and left side is tear dropped and I would like to be one cup size larger. I am a normal B and would like to be a fuller C. Can EVE correct my tubular shape and give me augmentation?

 

Answer: EVE alone could give you slightly larger breasts but will not give you much of a lift and might accentuate the tubular deformity. It is the combination of EVE and fat grafts harvested by liposuction that would help you best correct the tubular deformity and give you some lift.

Can you correct the inframammary fold?

To correct the tuberous breast…is there any incisions to lower the mammary fold or to loosen up the constricted tissue? I’m concerned that the fat injected along with the use of EVE won’t be enough for the breast to look more naturally shaped (like a drop).

 

Answer: Our procedure is a major breakthrough in the treatment of tuberous breasts. We make no incisions at all. We release the constriction with special needles, through a few needle holes that leave no scars. This is the best way to give you nice, round, natural shaped breasts without any scars and disruption of the breast architecture and of its breast feeding function.