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From: Hillsborough, New Jersey
Patient Type: Lumpectomy Reconstruction
Patient History: Breast Augmentation
I have been doubly blessed by Dr. Khouri's amazing development of BRAVA + AFT, undergoing both reconstruction and augmentation.
Between 1992 and 1995 I had three breast surgeries; two biopsies, and a lumpectomy. My second procedure was supposed to be a biopsy, but while under general anesthesia, the surgeon suspected a malignancy and chose to perform the lumpectomy. Fortunately each of the pathologies turned out to be benign fibroadenomas. However, the result of the lumpectomy was that nearly one-third of my left breast had been removed.
This truly added injury to insult for me. The original "insult" was my lack of breast development. From as young as 13 when I first menstruated, and my older girl cousins went through puberty and developed, I waited and waited for my turn to finally finish maturing. That experience of becoming a "complete woman" never happened, and the feeling of waiting never really dissipated. Unlike ladies with nicely developed A-cup breasts who call themselves "flat-chested," my 36AAA breasts, as seen in later breast ultrasound studies, were comprised of one-tenth of an inch of breast tissue, no fat, and about a quarter inch of pectoral muscle. While the internal structures (milk ducts) had developed normally, allowing me years later to fully breast feed my children, I still felt physically incomplete.
Throughout the years prior to my lumpectomy, I went through brief periods of wanting to undergo cosmetic breast augmentation but never went so far as to research techniques and surgeons. Instead, I began weight training as a way to give my breasts some volume or projection by increasing the size of my pectoral muscles. Over a period of several years, I put on 0.75 inches of pectoral muscle. The size increase I achieved could only be appreciated by someone as flat-chested as I. It, of course, didn't bring me any closer to feeling like a complete woman. I still longed to "just be in the alphabet."
I probably would have been more appreciative of that achievement, as well as the general fitness benefits, had the lumpectomy not done so much damage. However, it did lead to my eventual love for weight lifting and fitness in general. I became a personal trainer for a number of years.
A couple of years after my third surgery, I decided to consult with two plastic surgeons who both told me I was too flat to get implants. One surgeon placed a Kleenex® over the top of an implant and explained that having no breast tissue to cover it would expose the implant edges to show just as they did through the Kleenex. They both told me implants wouldn't repair or hide the lumpectomy damage since it was so far out to the side. Then the second surgeon explained that to try to hide the implant edges, he would insert the implants subpectorally. Once he said, "We detach your lower pecs," I made my decision.
"How can I perform decline bench presses?" I asked.
"Do you want breasts or do you want to bench press?" he responded.
"Both," I said and never looked back.
While thoughts of reconstruction and/or augmentation gradually diminished due to unacceptable options for me, the angst of having no breasts, and then one deformed breast, never faded. When I first started reading about fat grafting for augmentation and reconstruction in 2008, it piqued my interest. (Although it is funny now, once I developed hips and experienced other changes of puberty, I frequently said, "I wish I could put my butt into my nonexistent bra.") Now this seemed like it could be a distinct possibility with perhaps the potential to fix the lumpectomy defect.
I found a surgeon nearby in New York City (I live in New Jersey) who did fat grafting. When I called to schedule a consult in January 2010, they asked me if I was part of Dr. Roger Khouri's BRAVA trial. I had first learned of BRAVA and Dr. Khouri nearly 10 years prior because I had briefly considered trying BRAVA on its own but didn't think I had enough existing tissue to accomplish any growth. By now, I found the combination of BRAVA + AFT intriguing due to my interest in fat grafting.
When I found that Dr. Khouri pioneered this procedure, I immediately scheduled a consult and booked a flight for a day trip to Miami.
At that point, only a little information was available about autologous fat transfer. I did not know anyone personally who even heard of it, let alone who had undergone the procedure. There were no patient discussions on internet message board forums yet. But the Miami Breast Center's website (www.miamibreastcenter.com) and the clinical trials website contained information explaining the simple genius of how and why this worked better than traditional fat grafting. It sounded like an absolutely brilliant alternative to any reconstruction or augmentation method to date.
The couple of weeks between scheduling my consult and the actual day of the appointment felt like months; I was so very excited. When the date finally arrived and I met Dr. Khouri . . . "Wow! Just plain, Wow!" I recently heard someone describe Dr. Khouri as "a force of nature." Probably the best description to date! To say that his excitement and enthusiasm are infectious is an absolute understatement. But he is also jovial, approachable, considerate, and caring. By the end of my appointment, I could not wait to get started. Dr. Khouri explained how BRAVA would expand my breasts and create a "fertile scaffolding"— the space and blood supply necessary for the transferred fat to survive and thrive. He told me I would need to pre-expand my breasts with BRAVA for about four weeks. With eleven weeks until his next open surgery date, I knew I would jump out of my skin with anticipation and excitement, so I asked if I could wear BRAVA for those full 11 weeks. He chuckled and said, "The longer the better. Your final size is in your control!" Dr. Khouri scheduled me for an MRI. Then I began wearing my BRAVA. Those next weeks were nothing short of amazing. Watching the daily swelling of my breasts that the BRAVA domes created fascinated me. I felt like a teenager finally going through puberty. Even more amazing was how BRAVA began to pull out the several-inch area of my left breast that had been adhered to my ribs for eighteen years!
I have to say that my family and friends thought I had lost my mind. Seeing me with these massive "breasts" (the domes) was hilarious to them—my three children were in their twenties, and they and their friends were in and out of my house constantly. During the course of the many months I wore the domes, both pre- and post-op. I became a source of entertainment for them. Inarguably, this process required a very healthy sense of humor.
During my research, consult, and expansion period, I had begun talking to a few women on an online forum I own that is a support group for women who never developed breasts. I decided to take a deep breath and document/journal my entire experience with this process from day one, not just with words but with photos. I posted weekly pictures of my expansion and explained what BRAVA was doing and how it would ensure the survival of large volumes of grafted fat. A number of members on that forum became as fascinated and excited as I.
Over the course of my adult life, I have had 13 surgeries, including hernia repair, knee surgery, gynecological surgeries, and prior breast surgeries. Before each one, I would experience extreme anxiety. I hated the nausea I experienced after general anesthesia and pain medication as well as the post-op down time. However, as the date of my surgery—April 2010—approached, I could hardly contain my excitement about the surgery. I combined my trip to Miami with a spring break trip for my then 20-year-old daughter and one of her friends.
We arrived at a hotel in South Beach a couple of days before my surgery. In exchange for her helping me out the first 24 hours or so following the surgery, the two of them got the rest of the week to themselves.
Just before my procedure began, Dr. Khouri introduced seven surgeons from around the world into the surgical prep area to meet me and see my expansion. Initially I thought I would be embarrassed, but as soon as I saw the intrigue and fascination on their faces, I felt the same excitement as on the day I met Dr. Khouri. I learned that Dr. Khouri frequently trained surgeons from around the world in BRAVA + AFT. How thrilling to be even a small part of that!
My surgery went smoothly. I don't remember too much of my daughter taking me back to the hotel that night (except for being nauseous from the anesthesia). By the next morning, I wasn't feeling too bad. I felt a little pain in my breasts; it felt similar to PMS or when breast milk engorged my breasts. Soreness from the lipo surprised me. However, being used to muscle soreness following intense weight training, I realized that some type of light-to-moderate exercise such as just moving about, stretching, and walking would help ease discomfort and speed up the healing process. It would increase blood supply and oxygen to all parts of my body. In fact, the most valuable advice I feel I can give anyone during this post-op period is to stay active.
The morning after surgery I removed the bandages to take a shower and got quite choked up. Not only had I finally finished "developing" and becoming a "complete woman," but using an incredible technique called the Rigottomy to release the scar tissue and adhesion of my lumpectomy, Dr. Khouri literally erased that memory. He undid 18 years of damage, the source of so much angst for so long. I had surgery on a Friday, and by Monday I drove to my post-op exam, then to the airport. I do advise requesting a wheelchair for the airport to avoid the bumps and bangs of other passengers hurrying about.
I continued to journal my experience online, eventually creating a separate forum dedicated solely to BRAVA fat grafting patients—www.FatGraftPatients.com. By that point, many members became interested and decided to pursue this as well. They decided to journal their "stories" too. How exciting to follow their path along this fascinating journey! Some were having simple fat grafting augmentations performed while others decided to have complete reconstruction following mastectomies. Just as I experienced "developing" breasts for the first time, reconstruction patients experienced "regrowing" their lost breasts using BRAVA before their surgeries.
I wore the BRAVA domes for a number of weeks after my surgery to ensure the survival of the newly-transferred fat. My follow-up appointment with Dr. Khouri would happen in October. I combined this trip to Miami with another MRI taken to measure the survival of fat. I believe Dr. Khouri said I retained over 80%.
But the most exciting part of this trip was being asked to participate in the live-patient exam at a conference of 150–200 surgeons from around the world, attending to learn about this process. Sharing the one result of this procedure that I had not anticipated at all was the best part for me: I had regained full feeling throughout the entire area that had been numb due to the lumpectomy! I told them of the day I realized I had an itch where I hadn't had feeling for nearly two decades. The excited energy of that day was immeasurable.
During my follow-up exam the day before the conference, Dr. Khouri and I discussed a second procedure to graft a bit more fat to my lumpectomy area. It had resolved beautifully at that point, but I still had a slight indentation. That's when I realized that Dr. Khouri is truly and literally an artist. He is a perfectionist and will persist until your results are as spectacular as humanly possible.
I began wearing BRAVA again in November 2010, preparing for my December procedure at the new Key Biscayne Surgery Center. I discussed my issue with nausea with the anesthesiologist and felt better post-op than any of my other surgeries. I had help for just one night after this surgery. Being prepared for what the recovery would be like, I didn't feel I needed more assistance than that. A few acetaminophen and lots of walking around the hotel (along with a beautiful balcony view of the Biscayne Bay) was just perfect.
Again, several weeks of BRAVA wear post-op ensured the survival of transferred fat. By February 2011, I packed up my domes and placed them high upon my closet shelf where they sit today, tempting me. I admit that now that I actually have breasts, I'd like to see if wearing them for growth might work for me . . . but that is an experiment for another day!
It is now summer of 2012 and I have beautiful breasts that show no evidence whatsoever that they didn't develop on their own as nature intended. They are perfect 36B/34C breasts—further into the alphabet than I'd ever hoped for. My pectoral muscles are not damaged as they would have been from implants, and I can remain active and physically fit. I have no remaining evidence of the mess and misery I felt after my lumpectomy. I feel none of the prior numbness that produced the oddest, most unnatural sensation that I have ever felt. And yes, that "butt" (actually . . . saddle bags) that I wanted to move inside my bra . . . it's there! At 52 years old, I am more comfortable in my own skin than when I was 16!
As I said, I truly have been blessed by this entire process, but especially by having the great fortune to meet and choose Dr. Khouri as my surgeon. He is not only the most compassionate doctor I have ever met, he is also one of the most compassionate and selfless people. He could quite easily have continued performing flap surgeries for breast reconstruction as he previously had for over 20 years at far greater financial profit. Instead he developed, provided, and continues to teach what will (quite soon I'm sure) become the preferred, the norm, the most desirable procedure for breast augmentation and reconstruction.
God bless you, Dr. Khouri.
5 / 5 stars