Fat grafting to do breast reconstruction and breast augmentation is the future. After visiting Dr. Khouri and seeing him in the operating room, the future is here. NOW.
I just got back from my second training session with Dr. Khouri. My journey started two years ago when I attended his fat grafting course. He along with a handful of other doctors (Rigotti, DelVecchio, Coleman) is a foremost expert in fat grafting to the breast. They have many published papers on fat grafting. Khouri is the guy asked to lecture all over the country (and world), showing his work and teaching plastic surgeons how to breast surgery without breast implants and free flaps. And he is someone who did a micro fellowship and used to do all the big free flaps. Fat grafting for breast cancer reconstruction isn’t something he is doing because he couldn’t do a TRAM- he is doing it because it is better.
I went again to see him in action this time- in the operating room- where women fly in from all over the country to have him perform his magic. Most of the patients are breast cancer patients. Some of them had been reconstructed with implants and had issues: hardening, poor matching, poor sensation, migration, etc. Others had never done a reconstruction for a multitude of reasons. Some had radiation, some did not. And over the past week I saw back to back surgeries and post operative patients in all stages of repair.
Fat grafting makes sense to me. Why not use your own tissue to make a breast after you lost it to cancer, or use your own fat to make your breast larger? Why not move fat from where we don’t want it (yahoo!) and put it where we do?
So why did I not start two years ago after the first course I attended? Why? I am wary of anything “new.” I am never the first to jump on a bandwagon. I am critical of any doctors who are trying to make a new technique. Is this real? or is this a marketing gimmick? But I am impressed by everything I saw. What these doctors are doing is low tech- this does not need fancy lasers and instruments. They have studied it well, over years with serial MRIs to look at the architecture, volume, and changes, and they honed their techniques to improve fat survival. These are not doctors who are trying to make me buy a super-cool-fantastic-ultrasonic-laser which is going to make a breast with no downtime or scars and I only need to buy the machine for $$$$.
Dr. Khouri is a doctor who reminds me why I wanted to become a plastic surgeon. He is a thinker and tinkerer with great surgical training. The work he is doing with fat grafting and a technique called PALF is amazing. He is applying his fat grafting techniques and scar releasing (with small tiny releases to mesh it) to burn scars and hand surgery for Dupytrens contractures. The results are amazing and scarless.
I am a smart girl. These plastic surgeons are thoughtful innovators. For the past decade they have been refining their technique on how to do fat grafting. What size cannula? fat droplet? Do you centrifuge the fat or not? What speed, for how long? Do you use BRAVA pre expansion and post surgery? Are there patients you can’t reconstruct? What are the limitations?
Instead of me trying to invent this wheel, I decided to go learn from the best. They have tried every permutation and studied it. There are some limitations and issues, and I will address these in future blogs.
I am a convert.
I left Miami excited to get home and start. As I said before, I am critical or new things. I have been dancing around this idea of fat grafting to the breast for a few years. Fat grafting is not new. The refinements and technical points for breast augmentation and reconstruction are what I needed to hone. I got it.
Sign me up.