Reconstruction After Mastectomy

Reconstruction After Mastectomy

-Reconstructive surgery-

After a mastectomy, the last thing you want is yet another major surgery. With our EVE + AFT (autologous fat transfer) procedure you will not be cut open again. As compared to the traditional methods, this involves no incisions, no new scars, no foreign objects and it recreates a natural feeling breast with the benefit of liposuction.


Plus, you will keep as close to normal sensation in your breasts and nipples. The procedure is covered by insurance for breast cancer patients.


At the Miami Breast Center we understand that the breast cancer journey is filled with many emotions. This is why we want to ease your mind about your breast reconstruction decision.


Whether you’ve had a “simple” or “total” mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, or a subcutaneous (nipple-sparing) mastectomy, or are considering a prophylactic mastectomy, you are probably a good candidate for our breakthrough, minimally invasive breast reconstruction technique.

Our technique is explained in detail below. Please also visit the Breast Reconstruction Photo  page and Video  pages of the site. You’ll have a better idea of how we can help you on your healing journey.

Mastectomy Reconstruction Step-by-Step Case



Ideal Candidate Before Reconstruction


This woman is an ideal candidate for EVE + AFT breast regeneration. Her breasts are not radiated. She has loose mastectomy scars and ample fat. Since she also has bilateral defects, both breasts will regenerate symmetrically and we do not have to match a normal side. She is successful because she understands and is compliant with how EVE should be worn.




Expansion After Using EVE for Four Weeks, Before 1st Fat Grafting Procedure


After using EVE for 4 weeks, she has nicely expanded the mastectomy defects and presents for the first grafting session with “edema” breasts. This swelling is temporary as there aren’t any fat cells to fill up the stretched, loose tissues. If she stops EVE at this point and doesn’t have any fat grafts, the swelling will completely subside. Notice that while the left breast filled up into a nicely shaped mound, the right side is still dented by a transverse scar that EVE was unable to fully release.




Breast Expansion Inside EVE Domes from First to Last Procedure


These are lateral views of the left breast inside the EVE domes over the course of her treatment.


  1. 1, 2, and 3 show progressive expansion of the mastectomy over the first 4 weeks of EVE treatment before the first graft.
  2. Notice how the generated mastectomy mound has completely filled up the dome and she had to move to a deeper dome.
  3. Shows the amount of expansion at the time of the first graft.
  4. Depicts the expansion at the time of the second graft.
  5. Shows further expansion at the time of the final and third graft. Notice that she then had to graduate to an even deeper dome.





Before 2nd Fat Grafting Procedure


In this photo the patient is shown with her surgical markings for the liposuction and fat injection just before the second fat grafting session.




Before 3rd and Final Fat Grafting Procedure


This shows the surgical markings for the liposuction and fat injection just before the third fat grafting session. Notice how the dented scar retraction on the right breast progressively improves and will be the focus of treatment in this third and last procedure.




Final Results After Three Fat Grafting Procedures


The patient has regenerated large, symmetrical, D cup breasts after 3 EVE + AFT sessions over 6 months. These new breasts feel natural, just like the original ones. They are soft, bouncy, and best of all, the reconstructed nipple has near-normal sensation.

Am I A Candidate for the EVE + AFT breast regeneration procedure?


Most women are candidates for our procedure. There are only 4 disqualifiers:


1. Smoking. Smokers have a poor capacity to regenerate tissue. We recommend that a patient stops smoking at least 2 months before the procedure and abstain from even a single whiff or puff throughout the process and for 3 months after. If she cannot comply, we cannot help her.


2. Herceptin® Chemotherapy and Other Angiogenesis Inhibitors These prevent the revascularization of the fat graft and lead to a poor outcome. We recommend the process be started about 1 month after a patient completes her course of Herceptin treatment.


3. Aspirin and Other Over-the-Counter Food Supplements and Vitamins That May Impair Blood Clotting
We have seen disastrous results when a patient has prolonged bleeding time from long-term use of Omega 3 fatty acids, ginkgo biloba, garlic, ginger, ginseng, vitamin E, herbal tea, and green tea to name a few. It is imperative that the patient stops aspirin, all vitamins, and all herbal supplements at least 2 weeks before the procedure.


4. Poor Understanding of the Procedure and Inability to Comply With the BRAVA Expansion Treatment
Individuals that can not comply with the daily use of BRAVA to assure best procedure results. A large part of a patient’s success is tied to proper usage of the BRAVA for their circumstances.

Mastectomy Surgery

Ideally, the procedure begins in the hospital at the time of your breast cancer surgery. Dr. Khouri will join your oncological surgeon in the operating room. Right then and there, he will begin the reconstruction process by removing and then injecting some of your own fat into the breast area, so that you leave the hospital with a slight breast mound.


Note: For those patients who had a mastectomy in the past, the procedure begins with the next step below.

Benefits of Dr. Khouri’s Procedure

With Dr. Khouri’s micro-fat grafting procedure, you could be back at work within 1-2 weeks, while a full recovery can be expected in 3 months. No morbidity, no foreign material, no cuts or incisions, no new scars, and the patient keeps near-normal sensation in her breasts. All our patients love the side benefit of body sculpting too.

Issues with Traditional Breast Reconstruction

There are 3 traditional breast reconstruction alternatives. ALL involve major “open” surgery, which means muscle trauma and new scars.


  • The implant alternative involves the placement of a foreign object such as silicone or saline under the muscle and leads to an artificial feeling breast mound. Implants are not a permanent solution.
  • The tram flap surgery alternative involves taking a piece of muscle and tissue from the back or the abdomen and using it to rebuild a breast mound. The surgery is extensive, it requires major incisions, a prolonged recovery and the result is like patch work and still often requires an implant.
  • The DIEP flap procedure also involves a lengthy surgery with the removal of abdominal fat and skin. Though this is some of the best looking results, it is imperative that the procedure be done by a specialist expert who performs lots of these on a routine basis. Otherwise the morbidity, complication and failure rates are very high. And even the best results feel and look like patch work . This procedure also involves a prolonged recovery time.


This innovative procedure is the very first that facilitates reconstruction of an entire breast from fat with no major surgery.

Clinical Trials

Dr. Khouri has done clinical studies to prove the safety and efficacy of his procedure and has presented these studies at all the important medical conferences across the globe including the American Society of Plastic Surgeons Annual Convention. Dr. Khouri has the world’s best documented experience on the subject. Dr. Khouri’s work was just awarded the best scientific achievement at the Annual Meeting of the European Association of Plastic Surgeons (EURAPS) and he will be delivering his presentation and receiving the award at the Annual Meeting of the American Association of Plastic Surgeons. As a tribute to his contributions to microsurgery (this is how DIEP flaps are done) he will be delivering the Presidential Lecture entitled “Beyond Microsurgery”.