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 BRAVA. Should you still want to be larger, you will need to wear BRAVA 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.
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 BRAVA 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.
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.
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.
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.
Yes, Tamoxifen does not effect fat grafting. Many of our patients are on Tamoxifen. There is a slight increased risk of deep venous thrombosis (DVT), which is a clot in your veins that can dislodge and go to your lungs to cause pulmonary embolisms (PE). Although this is very rare, it can be serious, and for these reasons, we typically ask that stop Tamoxifen for 2 weeks prior to surgery. You can resume it a few days after surgery, once you are ambulating more regularly.
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.
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.
