38 year-old undergoes Implant Removal with Bilateral Tissue Advancement & Fat Transfer -- Dr. Roger Khouri, Miami Breast Center
This is my background BEFORE finding Dr. Roger...
I'm 38 years old and have had four children, via natural childbirth (natural, meaning not cesarean).
Just after high school graduation, when I was 17, I surreptitiously had my first set of implants. My dad is a guy; so I knew I could fool him, and my mother was out of town.
I also lied and told [my original] plastic surgeon, Susan Vasko MD, who I naïvely chose solely based on her gender, that I was 18.
Now that I think of it, I have no idea how I was possibly allowed to have surgery if I wasn't a legal adult. I don't remember, but I wonder, "Did the hospital, where I had the procedure, NOT ask to see a proof of ID?" Geez.
Anyway, before the surgery, I was extremely thin and thus had very little breast tissue. I was approximately a 32A.
I had pretty breasts--yea, for a 12 year old, but no matter what, I couldn't get cleavage, even if I wore the biggest push up bra out there--which wasn't saying much, because this was before the miracle bra, water bra, or all those other off-shoots.
This one and only doctor, which I hastily chose, inanely advised me to get textured implants, placed over the muscle. (Please note that at that time, silicone had been banned.) I blindly agreed, not listening to, or really understanding, any of the possible drawbacks. I was just excited to try on the different sized implants under my shirt, and imagine how great I would look after surgery. I eventually picked 300cc implants.
Post surgery, after the swelling went down, I wore a perfect 34C bra. (Based on what I learned when I worked at Victoria's Secret, a 34C has the same CUP-volume as a 32D--but since that size was very rare then, I wore the next best size--a 34C.)
As I was saying, my new size was perfect and my breasts looked beautiful...
BUT.......as soon as my swelling went down, my boobs looked HORRIBLE.
WHAT was my surgeon, Dr. Susan Vasko, thinking??? I looked like I had warped, plastic "Capri Sun" juice bags stuffed under my skin.
I was very self conscious in a bathing suit BEFORE the surgery, but after surgery it was almost worse! The only way to hide their artificial look was to wear an exercise bra-styled bikini top or a modest one-piece bathing suit.
And I was so self conscious of my new protrusions, that I don't think I ever let any boy touch them--not until I was 21 when my first fiancé told me they looked and felt like the "Capri Sun" juice bags. (He didn't intend to be hurtful, but he was right!)
Eventually one of the implants started to drop--not in the
Rock-in-The-Sock way, rather it was sliding down, past the bottom border of the original pocket. So my nipple position became extremely high and the inframamary fold scar was now halfway between the new fold and my nipple. And so it was visible if you looked straight on, at me. I think the term for this is called "bottoming out".
Fast forward a few years, and I was 23. I decided it was time for a change; so I stupidly went back to my original doctor and had a revision. I signed up for the Mentor implant study and became one, of only a select hundred or so, to be allowed to have silicone implants!....I was going to be a Guinea pig.
My doctor, who obviously hadn't learned anything in the 6 years that had past, thought it was logical to put textured silicone implants, above the muscle--AGAIN.
Well, the SAME rippling problem occurred--not as drastic as with saline, but nonetheless, the rippling was both palpable and visible.
(Grrrr x 2)
So less than a month later, my doctor kindly replaced my second pair, with a third, and did it free of charge, though I still had to cover operating room and anesthesia costs...again.
My third pair of implants were smooth-shelled silicone, and were placed under the muscle, ...and I think I went up from 300cc to a 325cc or 350cc, but I can't exactly remember.....
And guess what--when the swelling from my surgery went down, I could STILL see a bit of rippling between my breasts and even a weird bump on my left boob!
Not too long later, I went skating with a friend, and after doing this super-fast, couple-spin thing, he lost his balance and took me down with him. The impact with the ice caused my left implant to pop out from underneath my muscle. The pain was EXCRUCIATING. And I was terrified that the implant had ruptured; so I rushed to get a mammogram.
Much to my relief, my left implant was, indeed, still intact--but unfortunately, it was now ABOVE the muscle, instead of underneath it. In other words, my implant, placed below-the-muscle, had SLIPPED into the old sub-glandular pocket! [Aren't competent plastic surgeons suppose to do something, I dunno, like throw a few stitches in there to keep this from happening?
(Grrrr x ?)
Then, about four years later, I went on a raft ride and was being towed dangerously fast, behind a boat, when the driver took an overly sharp left turn. I flew off, and I smacked my left breast--again! Yes, AGAIN!
I believe it ruptured then, because since that happened, the implant no longer has had palpable edges.
[(GRRRRR x ?) + 1]
On another note....
As I've said, I have given birth to four children and had MAJOR complications with nursing--probably from having my breast nerves severed three times and having my breast glands messed with more than they should be. Somehow, though, I was able to successfully, though barely, nurse my youngest two--but that's probably because they were constantly attached to one boob or the other. (I'm one of those weird women, who breast fed her her infant while still nursing her toddler--this was not the case with my oldest, however, who needed to be supplemented with formula because of my insufficient milk production. And my second child, never got a chance to nurse, being that he born too premature to do so.)
To top it off, my right breast formed a capsular contracture--a grade IV, nonetheless.
On the left side, I have a large, very soft, but still mildly ripply, ruptured "rock-in-the-sock" ptotic breast that, because of not having my pectoral muscle to act as an internal bra anymore, sits 1.5" lower than my right, smaller-looking, spherical, grade IV capsule contractured breast--which I just found out is ruptured as well. Ahhhhhh !!!!
[(GRRRRR x ?) + 1] + (GRRRRR x ?) hashtag Hashtag HASHTAG
That means I HAVE HAD IT with these fake, nasty, cold, gross pieces of oozing, plastic sacks.
I have felt utterly HOPELESS--who wouldn't???
One day I sat, dejectedly thinking about my dire, yet hopeless situation, and a memory popped into my head. It was of my father, talking about how doctors are now able to take fat from problem areas and move it to more desirable ones. So I googled "fat transfer to breast"--and came across Dr. Roger Khouri's site!
My new story begins here...
Just so you know
"(Grrrr x the infinity symbol)" which this site doesn't recognize. So the joke isn't as funny.
Grrr again. Haha
My surgery day experience
Prior to liposuction, Dr. Khouri injected fluid into my inner thighs, belly, and flanks that contained an analgesic and something to shrink my blood vessels.
I got out of surgery about 8:30pm. I only remember waking up at 9:15pm or 9:45, shivering HEAVILY and feeling incredibly nauseous. I was given a cocktail of Dilaudid for pain, Demerol for shaking, and a combination of. Phenergan and Zofran for nausea.
The drug cocktail must have helped, but when I was discharged a little after midnight, and had to stand up, I was in excruciating pain and still felt incredibly sick to my stomach.
Why was I there so long? Remember--my surgery entailed more than the usual patient, undergoing breast augmentation with fat grander. I had a very ptotic (saggy) left, implanted breast that needed to be lifted. Dr. Khouri did this without any incisions, by taking skin from under my inframammary fold, and lifting it up with internal stitches. And he also created a kind of internal bra by putting additional internal stitches above the breast and, I think, around it....I have no doubt in my mind that my original surgeon would NOT be able to perform or even imagine this type of non-invasive reconstruction!
I don't know what he did with my right breast that had a grade IV capsule contracture. I'm assuming that wasn't too difficult.
Oh and, shhh, I even got bit of fat put into my cheeks and on either side of my nose. Unfortunately, my face is now PURPLE. Oh no! What will I tell people? Seriously-- got any ideas?)
About the operation:
I didn't have enough fat to do a butt lift and thank heavens I didn't, because I don't know HOW I would be able to lay on my side, as I can't even lift my arms at all. And how does one lay on her side if she can't move her arms?
I also didn't have enough breast tissue to hold all the fat that I needed to obtain a nice size. And since it is strongly not recommended to use Brava with implants, I could not grow any breast tissue before this surgery. So Dr. Khouri had to put in 130cc implants (to keep me from being too flat), which he will excise in 3 or 4 months, when I return for a touch up. I CAN'T IMAGINE, though, going they this again. Ugh.
Dr. Khouri -- I wish I went to him 21 years ago!
He finally agreed to add a bit of fat to my derrière until the day of surgery, when he changed his mind. He needed all the "precious fat" as he put it, for my breasts. And I'm now glad of his decision, as I can't imagine not being able to lie on my back while recovering from this HUGE breast surgery!
Day 1 post op
I woke up in the middle of the night, just short of 3 hours after my last dose of pain meds. My pain was tolerable until I had to sit up and walk to the restroom. OMGsh--I felt like I had gotten run over by a car, and someone was pealing me off the pavement, it was that bad. (But it's not that bad at all when I'm just laying in bed.)
I dribbled blood on the way to the bathroom, onto the toilet seat, and back into my room where I carefully fell onto the blood-stained white hotel towels and the nighttime bed pads--or whatever those things are called--so your child's nighttime accident doesn't soak into the mattress.
I had to wait awhile until I could take another dose of pain killers because the Percocet directions are to take every 4-6 hours. (Actually the medicine is "Endocet").
To combat the nausea side effect of opioids, I was prescribed the anti-emetic drug, called "Ondansetron" (Zofran).
This next part may sound off the point, but you'll see, it will tie into my story.
Ok, so in my "Surgery Day" post, I forgot to mention that my menstral cycle used to be 35 days long. Then over the last year my cycle has shortened to 29 days. Based on this pattern, I should have gotten my period on the tenth of this month. (I knew I wasn't pregnant because I've been celibate for over a year as I'm in the middle of a divorce--but that's another story).
Anyway, I was waiting and waiting for Aunt Flow to arrive, and with my typical non-punctuality, she rudely showed up JUST as I was giving a urine sample, RIGHT BEFORE surgery!
This mild embarrassment wasn't too bothersome as I have such a light flow. And I'm sure there was enough blood on the operating table to hide my menstral bleeding.
Anyway, I would have been just fine with a small pad or panty liner placed in the surgery undies. But, nonetheless, the nurse in the recovery room sent me home in a diaper. Not a big pad, but a REAL, adult sized DIAPER!
Once I got back to the hotel room and had to use the facilities, the diaper became awkward. It hurt to pull down; so I took it off.
Then at 7:30 this morning, when I went to use the restroom again, I sat down--I was just too wobbly on my feet to hover. And my mother was cat-napping since she had a hard time sleeping through the night.
As I sat, going potty, I could feel the warm sensation of urine flowing down my leg into the compression pants. Only some of it made it into the toilet! But I was in so much pain that I didn't even really care, though I knew this wasn't a good thing.
When I had finished, I stood up to wipe and realized my bottom was much lower than it should be--that's because I was STILL wearing my diaper! I guess I DIDN'T take it off after all! And it was full to the max--Now I know how my kids must have felt when they had a soggy diaper.
I had to rudely leave the soggy mess of my diaper on the ground because it hurt too much to bend over and get it. Then I waddled into the bedroom, while leaving a trail of dripped menstral blood and fluid from my liposuction sites (some of the 6 Liters of fluid he had injected prior to lipo), which was running down my legs. I know this sounds gross, but if you're going to have this procedure, then you might as well know what to expect.
At least "The Mutiny", the inexpensive, yet posh $119/night hotel, only with the Dr. Khouri discount, and with a bay view, has a washer and drier off the living room so we can wash the towels. There's also and a full kitchen, a breakfast nook, a pull-out couch in the family room, and a bedroom with a queen-sized bed.
My advice to prepare for post op, is to ask the hotel for clean but old towels and to buy nite time bed pads before surgery.
I think I'll also write another blog about how to plan for staying in Miami--just some fun and helpful tips!
Posf op, Day two
In order to get out of bed, I have had to rock myself forwards and backwards, over and over again, to gain the momentum needed to get myself into a seated position--I don't know why I chose to lay flat on the bed, rather than lying, propped up--But nonetheless, the rocking motion worked--even though it felt like I was pulling out my stitches...
No, it was WORSE than that! The rocking motion and the act of standing up made me think of how a LIVE roasting pig on a spit would feel, while having its rib meat carved off of its bones--it was THAT BAD.
And it also felt like I was compromising many of the liposuction sites, Iike my exertion was literally forcing the healing wounds to rip back open.
Every time I would walk to the bathroom, my wounds would leak, leaving a path of serosanguinous fluid (i.e. blood-tinged discharge) on the floor. I'd also leave blood on the toilet seat, which I had a difficult time wiping off, because it hurt so much to bend over--and also because I was worried that if I leaned over, I might faint and ruin my big investment in Dr. Khouri's eight hours of hard work.
As I made my way back to bed, I had to be careful again, not to slip on the blood-spattered trail I'd left on the floor. Then, I would cringe, preparing for the unavoidable pain again.
I'd carefully sit on my bloody bed linens, (which consisted of waterproof pads topped with a towel for comfort) and, as I cried out in pain, I'd fall back onto the pillows with a heavy THUD--I just DO NOT understand how some of you ladies make recovery seem so painless. You are probably also those lucky women who didn't need an epidural during child birth.
On the other hand, lest I scare any newby, fence sitters from having this procedure; I need to point out that once I get back into bed, I honestly feel little pain--just slight discomfort and itching, which can mostly be relieved by taking Benadryl...Remember, "No Pain, No Gain", but also remember that pain is fleeting.
Back to my long-winded story...Once back in bed after the excursion to the restroom, I woke up AGAIN three hours later. I hated this because I couldn't get back to sleep, but I wasn't due to take any pain meds either; so I had to patiently wait, feeling slightly delirious...and a little bored, too.
Then after I took my meds at 4am, it took another 90 minutes for me to drift back into a fitful sleep, full of nightmares of me, leaving my family, un-showered, in dirty pajamas, and without a plan. As I hastily packed, worrying about my animals (but not my kids??? Maybe I was going to take them with me.) Anyway, the entire time (in my dream), my mother-in-law was guilting me and belittling me, and giving me a lecture on what a bad person I have been.
In the next nightmare, In front of me stood a tall, sinewy man with piercing blue eyes, pupils--small as grains of sand, and with four-day old stubble. He had a gun had a gun pointed right between my eyes. (I think he kind of looked like the second guy to rise from the dead in the TV drama, "Resurrection", except this guy had sandy, chin length hair.)....Anyway, I was terrified, but somehow I knew I was dreaming; so, with trepidation and all the while, second guessing myself, I told the man that he couldn't hurt me because he was a FIGMENT of my imagination. (Kind of like "Divergent" huh?). Well the guy shot me anyway, right at my face and I swear I felt it!.... Then I woke up.
It was 7:45am. I dozed again until 9:20am, when I decided to finally crawl of bed. I was worried that if I didn't get up and move around, I'd get bed sores, but my mother, who used to be an RN before I was born, told me I wouldn't develop pressure abbesses that quickly.
Blanca, Dr Khouri's nurse called to remind me to shower (or was that yesterday?). She ordered me to leave my compression pants off or else my legs would heal with permanent marks, where the garment's elastic and zippers pressed into my flesh.
Soon after that, after one of the half dozen times my mother walked from our apartment in the Mutiny hotel, to Cocowalk (a small, posh, outdoor shopping center in Coconut Grove, FL), she came back with a thermometer, and later, a bottle of Colace (a stool softener) and Milk of Magnesia.
I had felt warm to my mother. and don't mothers know everything?--at least when you're the mom....So, my temp read 100.0*F, Blanca, the nurse told me my fever was because I hadn't had a BM yet. Only time will tell. And hopefully she'll be right.
I do tend to be overly descriptive of mundane things. So I'll try to shorten this up....
I have been having headaches, that I'd attributed to my narcotic pain medicine. Then when I went into the kitchen to cut up some Papaya (my mother was gone again on one of her half a dozen missions, which I'd encouraged to do), And I realized that I hadn't had any caffeine for two days. No wonder! I was having withdrawal headaches. So I fixed myself a small pouch of Starbucks Via (instant coffee that is more expensive than it is worth--but, nonetheless, better than nothing). That seemed to do the trick.
I also sunbathed twice on our balcony for twenty minutes a pop. I wanted some fresh air, but more so, I had hopes that the UV rays would help break down the bilirubin in my bruises (remember that I got some of my fat pumped into my face--over my cheek bones and around my nose--I think Dr. Khouri also put some in my crows feet and my forehead, but none in my lips. Anyway, the bruising in my face looks suspiciously like I have had plastic surgery)
That leads me to my next story, which I forgot to mention in my surgery day blog....after I was discharged from surgery and we got into our rental car, I called the hot, Latin, Mutiny Hotel concierge, Victor, to request a wheel chair. Since they were out of them, Signore Victor, rolled me into the elevator on one of the wheeled office chairs.
We got into the lift and then it stopped on the wrong floor. The doors opened up to a tall, slim, gorgeous, long, glossy-haired brunette (who was a also carrying a Louis Vuitton Palermo GM bag). She looked at me, aghast, probably seeing someone either just beaten up or who just got a boob and nose job, So I quickly and bluntly stated, "I had my breast implants removed with a fat transfer--that they also put into my nose to even it out because I broken it several years ago."
The shocked woman still had a look of horror, with mild amusement on her face as the doors closed. (Well, I'd like to think she was amused).
My mother later told me that I was probably so candid because of the anesthesia that hadn't worn off. And I said "No I would have say that anyway [meaning, under any circumstance] I'd rather tell someone why I look weird, than for them to think of the worse possible scenario!" (And doesn't the statement, "I just had my implants removed" seem less distasteful than the picture of me that screamed, "I just got a boob job"?)
Back to day two-- I ate yummy grilled shrimp, "Pâté de Foie Gras" (i.e. Goose Liver Pâté), fried goat cheese, and frozen yogurt. (I'm telling you, Coconut Grove is a GREAT place to have your surgery!) Unfortunately, however, most of the food wasn't as palatable as it should have been, because the pain meds have taken away my appetite--But just wait, in the middle of the night I'll probably wake up craving that same foods and quietly sneak into the kitchen so as to not wake my mother, and gobble them up, all the while, wishing they were still hot.
On another note, I finally put on underwear. Remember my diaper scenario? Because I still have drainage, I opted for the surgical undies with a panty liner--but no more diapers!
I must be doing better since my modesty is returning. And I thank The Lord I have my mom here instead of my husband as I was sleeping in the Full Montey---except for my wrapped-up chest. It's just...guys can get turned on at all the wrong times. That would totally have freaked me out.
But I'm back in the buff now, because I'm afraid the strings on the surgical undies will leave an indentation in my healing tissues.
Also, I finally propped up pillows so I could get in and out of bed more easily.
And last, it almost looks like Dr. Khouri fixed my umbilical hernia after all. He was originally going to mend it, but told me that I needed so much other work done, that a hernia repair would just be too taxing on my body....I'll post a picture; so you can be the judge. But I'll find out anyway at my check up appointment on Monday. (Today is Saturday--well now it's officially Sunday since it's 1:57. What? OMGsh. I should be sleeping, not blogging)
PS, I passed much of the time today by reading a bunch of reviews from you fine ladies, here on Realself---but, please, you need to write more, WRITE MORE!! And I also watched youtube videos of people showcasing their Louis Vuitton handbags and accessory collections. I could have had several of those--WE ALL could have--for the price of our procedures! But I do think that this surgery is a better investment, don't you?
Questions are answered on Post op, Day 3
I opened the drapes and windows, walked around the flat for exercise, sunned myself on the balcony while watching racing bicyclists speed past in pursuit of the gold, and even fixed myself some food--without even having to step outside of the room!
If you plan to have your surgery in Miami, please consider the Mutiny Hotel. This ocean-view skyscraper boasts room suites that are actual apartments, with full kitchens--stoves and all--and washer/drier sets. Half of the apartments are checked out to customers and the other half are owned by wealthy individuals. When some of the owners leave town, they give the hotel, the rights to rent out their flat--and they, then get a stipend in return--These are NOT Time Shares, rather these are actually living quarters, where French-speaking couples and graceful old ladies can be seen walking around with their tiny dogs, and living the dream life. And the price of this hotel for me, with the surgeon discount, isn't much higher than that of a Miami Holiday Inn!
Sorry. I digress too easily....Stay on topic. Ok I'm going to stay on topic. (Remember the orange-clad Federation fighter pilot at the end of Star Wars (he was on Luke and Leah's side), who kept saying "Stay on target...Stay on target" before he got shot down?
Anyway, where was I? So with the unavoidable chance of losing my readers due to impropriety, I'll just take risk and be blunt: With the invasiveness of this surgery, strong narcotics are needed for pain control. Unfortunately, one notable side effect of opioids, is constipation--even for those who are not prone to the miserable affliction.
In my case, I had not "relieved" myself since Wednesday morning (the day before my surgery and almost five days from the present time). Since I was eating like I was trying to gain weight, there definitely was a problem.
Having a BM is one of the most important post operative cues that tells the surgeon his patient is good to go. Because my post operative check-up is tomorrow morning, I decided I needed to take action. So throughout the day, I drank shots of Milk of Magnesia....but to no avail. It's like it was counterfeit medicine or something--that does exist, you know.
My tight belly kept getting more descended as the day wore on...so I finally took a HUGE gulp of the chalky, mint-flavored stuff. And not too long after, I felt like I was giving birth to a tape worm on steroids. I even thought I had prolapsed (pushed out) my uterus! I was so scared.
I'm SO INCREDIBLY SORRY for the disgusting image I'd just painted, but there is indeed a lesson in this--
DO NOT FORGET TO BUY AND TAKE YOUR LAXATIVES.
I am due to leave Miami on Tuesday morning (in two days) and I have no idea how much pain I will feel when my lidocaine pump is removed. (Every hour, this automatic pump, which is connected to some vein or another and which hangs over my head like a big necklace, administers the analgesic, "Lidocaine", into my breast tissue--and even, oddly, into my belly button--which is why I still kind of think he fixed my hernia after all.) I am hoping that Dr. Khouri's office will let me keep this pump for another week, if I put down a deposit, which could then be refunded when I ship it back.
Oh, another reason why my pain has lessened is because the nurse gave me permission to take two Endocet (Percocet) pills at one time, instead of just one, every 4-6 hours. I don't want to waste the medicine and take two at each and every dosing, but just the KNOWLEDGE that I can have more, helps me to better tolerate the pain--This is now widely known and why hospitals and hospice centers now use manual pumps--A patient's anxiety is usually greatly reduced once she has control of her pain management.
On another note, most of my drainage has stopped. And as I've stated in another thread, the blood loss in my pictures looks horrific, but it was actually minuscule, as only a small amount of blood was mixed in with the serosanguineous fluid, that had oozed out from my lipo sites......One blood drop mixed into a bucket of water looks like a lot, though it is not.
Two people have asked me if it is difficult raise my arms, post explant. Yes it was hard--I'm still not able to raise my hands to put my hair in a pony tail. but now my range of motion is getting broader. Here's my guess as to why this happens:
Implant removal with fat grafting harvested via liposuction, is a HUGE surgery. First, the doctor must make an incision to excise the implants. My surgeon, Dr. Khouri, for instance, makes his incision, not on the breast, where the grafted fat can find it's way back out, but on the area of the torso, directly below the armpits, where it will be hidden under a bra band.
So that area is obviously going to be tender. And since raising the arms stretches the skin, the incision area is automatically going to be aggravated.
Also, I'm assuming that, after removing implants, the doctor must dig around inside the pockets to rid them of all the implant matter, especially if the implants were ruptured silicone ones.
Also, in my case, I had an internal breast lift on at least one breast, but I think both. To do this, Dr. Khouri has had to place stitches under my skin, and ALL around and underneath my boobs, which then pulled the skin upward to create a new inframamary fold. This obviously would create more tender areas, making it harder and more painful to raise my arms.
But, if I remember correctly, I couldn't raise my arms after my first, second, or DEFINITELY my third breast augmentation/revision either! Could you? I don't think so.
Last, there was a question about whether I am going to use Brava after I heal. Well, I chose plan B--which was temporary placement of tiny implants if not enough fat could be transferred during this surgery, with the plan of getting them removed in the fall when I come back to have a touch up.
Dr. Khouri, who actually invented the Brava, told me I can't use it with implants--I'm guessing this is because the contraption could cause the implants to rupture. Also, those who have scars bigger than one inch may have them worsened by Brava's strong suction.
The lucky ladies who have gone from virgin, untouched breasts to fat augmented breasts, don't have to worry about any big scars stretching out, like we, implant removal ladies, do. And they probably feel less pain after their surgery too.
I hope all of this clears up some lingering worries
Part 1: First Check-Up, Day 4 Post Op
In short, the nurse removed the long silicone catheters from my breasts, that were delivering almost constant Lidocaine for localized pain relief. None of the tape was removed--so the support tape was kept on my left breast (the "sock-in-the-rock" breast) because the skin was more stretched and thus more delicate than that of the other side, also the pressure tape was kept below my breasts--and I'll tell you about that later.
After, the initial celebratory glee when Dr. Khouri caught sight of his masterpieces--my black and blue, half taped-up breasts, one of the first things the doctor noticed was was the almost assuredly PERMANENT indentations that my blue, surgical underwear had left on my malleable post-liposuction hips--I had worn them for only ONE day! At least the doctor said he could fix those areas during my touch up visit. But he went on to tell me that from now on, I shouldn't wear anything with a draw string or an elastic band. I got a bit confused because his nurse had told me to stop wearing the compression garment the day after my surgery, because it could leave marks. So if I can't wear the compression garment, but can't wear anything with a band that will leave an indentation, what's left that I can wear? Seriously, I'm really confused.
I can't imagine not wearing underwear because of reasons you might guess--I'm not menopausal and not on any birth control; so if you understand normal female cycles, or if you have ever learned Natural Family Planning, you will have learned that as unappealing as this sounds, the cervix continuously creates mucus--sometime less and sometimes more, or A LOT more, like when the woman is fertile (this helps with sperm mobility, etc). In other words, I like to feel dry and thus I wear undies and sometimes thin pads for this reason. I just CAN'T imagine walking around all day without any underpants on--especially during the week when I'm becoming fertile--and the week of my period!
Perhaps I will need to get over this, because I really don't want odd, deep, permanent indentations on my hips.....So then, why exactly can't I wear high waisted, long-legged compression garments? Wouldn't they be better?--On second thought, going commando sounds much more appealing than a half-body, elastic girdle.
WAIT, I KNOW--one of the biggest fashion styles in Miami is a long free-flowing spaghetti-strapped dress. THIS would solve the problem of waistbands leaving permanent indentations...OR I could find some high-waisted brief undies, and some high-rise pants to match--but where can one find these nowadays? Maybe Walmart has the ugly granny panties and then I can get XL scrub pants and hike them up to my waist. Wow--won't I be at the height of fashion for the next 1.5-3 months?!
Part 2: First Check Up, Day 4 Post Op...Explanation of Procedure & Reason for Changing Name of Blog
The implant shell in my squishy breast had COMPLETELY DISINTEGRATED, leaving free flowing, yet sticky silicone, which made for a difficult excavation. The other implant was still intact, yet it was unmarked, except for the size, which was 300cc. Dr. Khouri said it looked like the type of off-market implant he would expect to have come from China's black market, and then asked me again who was the surgeon who put these into me.
I wonder what had happened--I THOUGHT I was part of the original Mentor Silicone Implant study. Perhaps I did originally receive legitimate Mentor study silicone implants. What if when I complained about the visible ripples left by the medical study implants, (textured silicone, placed over the muscle) and when I demanded a redo, my doctor, Susan D. Vasko MD, used crappy tester (for trying on in bras) sample implants because she couldn't be bothered with acquiring legitimate ones? I don't know. I need to call this surgeon and ask, "WTF...?"
Nonetheless my present surgeon, Dr. Roger Khouri, could not find any manufacturer's name or any model number on the implant. Fishy, huh?
Why Was it Difficult to Sit Up and Raise My Arms After Surgery?
When I had my first set of implants, which were textured saline, placed over the muscle, the recovery was somewhat painful and it was hard for me to sit up and raise my arms.
When I had my third set of implants, which were smooth silicone, placed sub-muscularly, it was extremely difficult to sit up and raise my arms. It was SO EXTREMELY painful that I SWORE I would never go through that again.
Well, that was NOTHING compared to what this surgery was like! Perhaps recovery could've even been worse, but I had my willing and more than able (once and RN always and RN) mother to take care of me. And also, I'd already been seasoned toward pain--through my experiences of childbirth, infections, and even painful bunion surgery. So perhaps I'm more able to stand the pain and discomfort of this surgery, now that I've already experienced so much! That's not much for encouragement, though, is it? Well read on and decide for yourself if it was worth all the pain. (Remember, no pain, no gain)
The tightness I'd been experiencing was because my reconstruction included a "Bilateral Tissue Advancement", wherein Dr. Khouri used dozens of tiny pin pricks (instead of incisions) to separate and dissect my upper abdominal skin from the fascia and muscle underneath, to which it had been attached, and pull it upwards, to form new breast tissue. So, in other words, he pulled my loose, upper-abdominal skin, located just north of my naval, and took out the slack--much like a reverse tummy tuck. Instead of cutting out that excess skin, like the surgeon would do in a tummy tuck, Dr. Khouri used the tissue to form the basis of my new breasts, since my original breast tissue was so damaged and stretched so thin.
How Was Dr. Khouri Able to Keep My New Breast Tissue in Place?
Carefully placed sutures were used to pull up and advance the skin from my abdominal area to its new position--my breast area. He also used additional stitches up and around both breasts to create an internal bra.
Since these sutures will be absorbed in about 6 weeks, to keep my new breast tissue from falling back down to its original position (on my upper abdominal area, just above my navel), I've been instructed to continually wear a strong type of compression tape, called "Rock Tape" (it's like Kinesio athletic tape) on my torso, starting on one side of my back, up on my shoulder blades, then wrapping around the front and going under my breasts and back up to the other side of my back. I'm suppose to wear this tape for 6 weeks to two months until I see him for a recheck. (But later on during a phone conversation with the nurse, I was told I must wear the tape for 10 weeks--so I'm kind if confused as to how long I'll need to wear it. I guess I will address that in a future update.)
The PRESSURE and SUPPORT of the tape will not only keep the advanced (moved) skin "stuck" in its new position, but it will also help the tissue fibers take root in their new home-- permanently.
I feel like I'm being too wordy--so hopefully this analogy will speak volumes:
Say you have a grassy steep embankment, that's ridden with weeds, and thus needs to be dug up and redone. You've chosen a certain slow-growing grass, maybe "Zoysia grass", that grows sideways instead of upwards.
Your landscaper brings rolls of uprooted grass and unrolls the sheets onto your embankment. (I don't know if Zoysia grass can be delivered in rolls, but remember we're talking about boobs, not grass--let's leave those arguments to another forum). Eventually these rolls of grass will take root, but until then, gravity is its worse enemy.
To prevent gravity from pulling down the new sheets of grass, the area must be pinned into place until the grass can take root--and maybe even awhile longer, until the roots become strong.
Was that analogy helpful?
What Were the Post Op Directions?
As a double precaution, I was also advised to wear a bra with a tiny size 32 band, with overly-large underwire cups, like size FF. Dr Khouri wants the bra band to be tight to help keep the tape keep my advanced skin in it's new position. And he wants the XL cups to fit loosely so they won't compress the breasts, which could kill the transplanted fat and/or alter the appearance of the breast, since the fat is still in its malleable state.
I'm assuming he wants me to wear an underwire bra so I will have lift and support for my new breasts. (Usually breast surgery patients are told NOT to wear underwire bras, but this does not apply to me since my doctor didn't make any incisions on my inframammary fold.)
I was told that my compliance and willingness to strictly adhere to the doctor's post surgical instructions is imperative and as important as the surgery itself! On the other hand, if do not follow his directions and do not keep reapplying new compression tape when the old tape starts to curl and pull away, then my new breast tissue will DISAPPEAR! It will literally slip back to its original position on my belly and my new, full breasts will be gone....Literally--gone, overnight.
How Does My Chest and Breasts Feel?
Because my skin was pulled as tight as a drum, I feels like I'm wearing a corset. And unfortunately my skin is going to continue to feel extremely taut for quite some time. Blanca, the nurse, said that I can find relief, however, by stretching--And that stretching will improve my new hunched over-posture, which will, in turn, lend more support to my breasts.
But the best part is that my breasts are soft and WARM. I've had cold boobs for almost 15 years. The boiling point of silicon is 4,274°F (2,357°C); so you can imagine that my silicone implants wouldn't have easily been heated up by a mere 98.6°F body temperature!
My breasts are still swollen and tender and thus don't feel as soft as they will, once the swelling goes down, but I can definitely tell that my cold, hard capsule contracture is gone. Praise The Lord!
How Many cc's of Fat Was Grafted?
I forgot to ask how many cc's I got put into my breasts. And, I'm not sure, but I am under the impression that I didn't receive the maximum amount of fat that I could have had transferred. I know fat was taken from my flanks and some from my inner thighs, because it is bruised and painful there. And I know that some of that fat was placed on the upper pole region of my breasts--like high on my chest to help with the whole cleavage thing, but I'm thinking that the doctor didn't load me with fat because he knew this surgery would require two stages.
I was under general anesthesia for such a long time because of the time-consuming work of removing of all the tacky, leaked silicone from my implant pockets.
Also, the "Bilateral Tissue Advancement" was labor intensive; so Dr. Khouri didn't even have time to mess with my old pockets. He used the old pockets (sub glandular on the left and sub-muscular on the right) when he placed the temporary implants, which were, like I said, the smallest size available, 120cc smooth silicone.
During the touch up procedure, my surgeon, Dr. Khouri, will remove the temporary implants and replace the lost volume, with grafted fat.
BTW, I'm changing the title of my Blog to reflect the type of surgery that I have had.....Originally, I did not really go into this surgery fully knowing what it would entail, and I don't blame the surgeon for this, because the removal of implants will almost always call for some type of reconstruction. And since my problem was so great, I needed a much more drastic surgery--remember one of my breasts was high, round, hard, and leaking, and the other was low, long, squishy, and leaking.
I'm hoping that other women, who will be having this surgery, will go into it knowing the great importance of following the post surgical instructions. What I do in the next 10 weeks will almost assuredly predict the outcome of my surgery.
If I comply--my results will be attractive and the surgery will have been successful. If I refuse to comply, the surgery will be a failure.
It's kind if similar to--if you get a Brazilian butt lift and sit on your tush, after the surgeon had explicitly told you not to, the grafted fat will die--you'll lose your new volume, your butt will be saggy, and you'll have no one to blame but yourself.
I'm ugly now. I regret this surgery
Theoretically, if the advanced skin is FORCED to stay it's new spot, then it will grow new roots and stay put in it's new position--as part of the breast tissue. But, on the other hand, if gravity takes hold, then it will pull the skin back down, and leave the horrible effect of odd-looking, bottomed-out breasts, with that tell-tale, double-bubble deformity which Dr. Khouri's other patients have unfortunately experienced.
From what other realself members have told me, Dr. Khouri has, in the past, solely relied on the internal sutured bra to keep the newly advanced skin in it's new home. But that has proven to be ineffective, since these stitches loosen (OMG the pain this causes is unexplainable) and eventually get absorbed. Without any painful internal bra, there is no longer anything to keep the skin from falling back down. And the reality is, that once the skin falls back down, it never returns to the spot that it once was! So the poor patient is left looking WORSE than before she had the surgery. Doesn't this sound like some crazy black market procedure?
So I guess I'm the newest guinea pig--I'm the only patient that I could find on realself, who posted concrete EVIDENCE of having had RAFT (aka, Bi-lateral tissue advancement) surgery WITH the additional use of tight, compression tape. Will I finally be the lab rat who has received the winning technique? Do I look like I'm a winner?
Back to my story--after I went into Target's dressing room, I painfully took off my bra. I could tell my Percocet was wearing off. That's right, six weeks post op and I'm STILL on narcotics and NSAIDS. It's surprising I haven't turned into an addict yet--but here and there, I'll stop taking the Percocets to make sure I'm not developing the signs of narcotic withdrawal. And my supply is running low anyway.
I wish I had been told I would experience so much excruciating pain. I wish I had been told that I would have the skin above my naval ripped off my underlying fascia and sewn up into breasts like an il-fitting alteration. I wish I had been told that I would have too much pain to pick up or even HUG my children and that I would have to ask my little kids to reach for things because the action caused unbearable agony. I wish I had been told a lot of things, but, sadly, I had not.
Anyway, I carefully put on the bathing suit top to avoid having to raise my arms, since when I do that, shooting stabs of paralyzingly acute pain, run from the nerves in my arm pits all the way down into my elbows. Actually as I type this, I'm having that EXACT sensation in my right arm pit and it's traveling along my nerve endings. I tell ya, I can totally empathize with those who have Fibromyalgia--and I worry that I, too, have developed this. Who knows--maybe in another year the pain will subside. But WAIT. I just wanted my implants removed with fat grafting! I didn't want this weird experimental surgery. And I certainly did NOT want the horrible evidence of this surgery to be visible for the whole world to see!
That's right. When I put on the first bathing suit top, I saw them--Long, red, ugly scars, which Dr. Khouri ASSURED me would be hidden. But they weren't covered AT ALL by the bathing suit.
Dr. Khouri said he didn't want to remove my implants via my old inframammary fold scar, because fat would leak out of there. But what fat? Fat that he injected? If I was already going to expect at least one more surgery after this initial procedure, then why couldn't he have waited to inject fat around that area until a later date?
Dr. Khouri said he didn't want to make any incisions on my breast -- but that's laughable, since I already HAD scars there! What kind of a doctor would think it's ok to add TWO MORE scars--but not where they'd be hidden--rather, in PLAIN SIGHT?
I would expect a $20,000 surgery to give better results! Am I crazy for expecting this? How many of us lab rats have to be disfigured before the doctor gets it right? Huh? I'm demanding to know......You know, my husband is a surgeon. And when he was in residency, he and his colleagues practiced new techniques on a pig. A PIG, NOT a human!...
Look at me! Does this look like something you would want to have done to you?
I was unfortunately seduced by all the hype surrounding the name of Dr. Khouri. I trusted him when he said my scars would be hidden and my breasts would be beautiful. In actuality, he performed an experimental procedure--a totally different surgery than I had asked for--one that would leave me in debilitating pain so that I couldn't even wash my hair or drive my car without having to cringe from the simple use of my arms................................ When I first posted on realself, one of Dr. Khouri's employees told me the whole staff read my review (it was positive at first). She complimented me, then ordered that I stop posting any pictures showing my bloody sheets and dressings. It is my opinion, though, that people on this site want the truth............................... Many times following my surgery, I contacted the Miami Breast Center, and each time, the staff minimized my horrible pain and unsightly results. And as soon as I posted the ugly truth here on realself--that I was used as a guinea pig, without my consent, for an experimental procedure that was far more invasive than I would have agreed to, they completely stopped contacting me......................... To be fair, if I had not gone swimsuit shopping, I would have given more stars for email responsiveness and follow up--even though I was made to feel like I was exaggerating and overly obsessing about my extremely difficult recovery. But the swimsuit shopping was the needle that broke the camel's back. Not even the more modest suits could cover up my two new, ugly, jagged, and visibly conspicuous, 2 1/2" breast scars that he created on my previously flawless skin. The sad thing, is that I already had two old scars--hidden on the bottom of my breast, on the inframammary fold, through which he could have gone, to remove my implants............................. Also, though Dr. Khouri spent a lot of time with me, I gave one star because most of that time was spent snapping COMPLETELY naked photographs of me or looking at my body, while, again, I stood there naked................................ I'm assuming that Dr. Khouri did not go into detail about the actual procedure--that, BTW, really should be done in a hospital setting and followed by a hospital stay, and not in an ambulatory surgical center, nor, I'm assuming did he not explain and prepare me for what type of recovery I should REALLY expect (horrible, paralyzing and long-lasting pain), because he knew I'd never consent to the procedure if he did.