COMPLICATIONS FOLLOWING REVISION WITH STAGED FAT GRAFTING

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Roger Khouri, MD
Roger Khouri, MD
Board Certified Plastic Surgeon
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COMPLICATIONS FOLLOWING STAGED FAT GRAFTING - DISTURBED ABOUT WHOLE PROCEDURE

  • 18 Oct 2017
I was diagnosed with breast cancer and had a bilateral mastectomy in May of 2016. In March, 2017, I had a consult with Dr. Khouri about RAFT (reverse abdominoplasty with fat transfer) after failed implant surgery post tissue expanders and exchange due to capsular contracture Grade 4 with constant pain and discomfort. I was looking for an alternative to implants because the likelihood of getting cc again once you have had it is very high. I had previously been told I did not have enough fat for flaps and I wanted to avoid another major surgery. I found Dr. Khouri and his RAFT procedure by searching online. I booked a consult and drove the 250 miles to Miami with my husband. His office is in Key Biscayne. I was immediately taken aback by his unprofessional office. You have to walk in through a dermatology office to get to his office. We were placed in a small exam room, I was instructed to remove all my clothes and was given a gown and we waited for almost 3 hours before Dr. Khouri and nurse came in. Dr. Khouri's examination included him taking at least 100 pics of my naked body while my husband stood and watched. Dr. Khouri then continued talking to me while I stood there naked. I asked for my gown three times and finally walked over and put it on. It was not professional and it was humiliating. Dr. Khouri does not listen to you. He does a lot of talking about how his method is far superior to what others are doing. He said he does not use Alloderm because he hates it, he uses the reverse abdominoplasty, which he described basically as an upper abdominal lift that was no big deal. He never mentioned a metal plate being screwed into your clavicle or that wire (or some other hard material. I have yet to find out what it is) is used to make the "purse string" that will hold your new fat grafted breasts in the right anatomic position, that it will define the fold. He did ask my husband and me what we did for a living. He told us that I would have warm, sensate breasts when he was finished. He told me that I would love the way the rest of my body would look post surgery because he would sculpt it with his fat grafting. He said he would be able to alleviate my pain, that he was going to release nerves, that he would be able to help with the numbness in my arm and down my back and that I would regain sensation in my breasts when he got finished. He said this surgery was minimally invasive and I would need three to four surgeries. At the first surgery he would remove the scarred implants, do the RA and do a lot of fat grafting. And even though I had been told by another PS at a consult that I did not have enough fat to create two breasts, Dr. Khouri said I had plenty of fat, no problem. I am 5'5" and 128 lbs. Dr. Khouri does not give you a chance to talk. When you do ask a question, he answers with a lecture and your question goes unanswered. I am sorry I did not trust my instincts after consult. I am sorry that I did not ask to see the surgical suite which is located right above his office. Dr. Khouri's office worked hard on getting approval from my insurance company. It was denied the first time it was submitted but with suggestions from them, it was approved the second time. The surgery was scheduled quickly after approval. They wanted me to have surgery in two weeks but I was able to do that, so we scheduled the surgery for August 17, 2017, three weeks after insurance approval. My husband and I arrived in Miami on August 16 for appointment with Dr. Khouri to mark me. It was late afternoon after driving 250 miles. The appointment was in Dr. Khouri's hand clinic in Miami. Once again, I felt uneasy about this office. The waiting room was full of people and the office was not clean and very disorganized. We were taken to an exam room that was obviously a dermatology exam room and I was told to remove all my clothes and given a gown. We waited for over an hour. When Dr. Khouri came into the room, he sat on a stool and placed his feet on the large old dermatology chair and kicked it across the room. The chair crashed into the pocket doors and knocked them off their tracks. When it was time to leave the room, we could not get out and my husband got down on his hands and knees and put the doors back on their tracks. Dr. Khouri drew all over my body and once again talked to me while I was standing there naked and I had to ask for my gown. He once again asked my husband and me what we did for a living. I asked him what his plan was in case of emergency during surgery since he operates in a standalone suite. He asked "What do you think will happen?" I said "Well, complications can occur quickly." He seemed annoyed at my questions. He said if I would develop a pneumothorax during surgery, he has a friend at Mercy who would take care of me. He launched into a description of pneumothorax and I told him I knew what it was. He seemed irritated by this. He told me I would not be intubated because he likes to maintain control of the airway. When we got back to our hotel, I questioned the fact that I had not been given an antibacterial wash kit. I wanted to shower, so I called Cindy, the coordinator, and asked her if I could shower. She said absolutely not because of the markings. Cindy changed my surgery time three times that evening. I was told the surgery was going to be two hours. My surgery was finally scheduled for 7 and I was told there was another surgery scheduled for 10. When I arrived at the surgical suite above his office, I went into a small waiting area. A male nurse greeted me and gave me paperwork to fill out. I asked him if I needed to do an antibacterial wash, and he said it wasn't necessary, they would do it before surgery. After filling out my paperwork, a male anesthesiologist came out to greet me. He had not shaved that morning and his eyes were bloodshot. It made me uncomfortable. I told him I was allergic to Demerol and this seemed to baffle him. He said they use Demerol as you are coming out of surgery to keep you from getting the shakes. I explained that during my past surgeries, they were able to avoid using Demerol and I did not get the shakes. I don't remember one more thing until I was in the portico of the hotel and my husband came around to get me out of the car and I started vomiting all over the place. I was humiliated. I have never thrown up after surgery. I've always remembered the events leading up to surgery and the events in the recovery room. The surgery lasted 6.5 hours. My husband was told several times during the surgery that he should leave, go to the beach, go out to lunch. He found this bazaar. Who leaves their loved one during a surgery that was supposed to be two hours and has now gone way past that time. Finally, my husband was called into the recovery room. He said it was not clean. He said I was laying on the table sleeping or still drugged. Shortly after he got there, they dressed me and sent me home. My husband was alarmed. Dr. Khouri never came in to talk to him. Once again, I don't remember a thing about the remainder of that day except that I was so thirsty my husband had to sit beside me with water and a straw because I cold not sit up or use my hands to hold a glass. My breasts were completely bandaged and I was told not to remove them until the postop visit five days later when I was instructed to get in the shower right before the appointment and cut the bandages off, which is exactly what I did. The next five days were agonizing. My lower back across the fat grafted area was extremely warm and painful. The center of my spine hurt so badly I could not sit up. A pain pump had been placed in my chest, so at this time that area was not the problem. I was nauseated and could not eat. I had been instructed to remove the compression garment on my lower body the day after surgery and not put any bandages on that area. The garment was a bloody mess. After removing the garment, blood oozed everywhere. When I got up to go to the bathroom, there was a trail of blood my husband had to wipe up. We thankfully had our own bedding and a couple of beach towels. We covered the bed and every time I got up, the bedding had to be changed because it was soaked in blood. 8/21/17 - Post-op visit with Dr. K and Blanca, his nurse. I have no recollection of traveling to their office. I don’t remember packing to go home that morning. Dr. K once again had me get naked and took a bunch more pics. My husband was in the room and I hated him looking at my battered body. Again, I had to ask to put my gown on when he was talking to me. He said what a great job he did, that they looked great. I asked why the surgery took so long and he said something like there was a lot of work to do. They removed some stitches and staples. They did not have gloves on. Blana and Dr. Khouri started cutting out this form to cover my breasts. I had no idea what they were doing. They were arguing over size, a 7 or a 9. K was like come here, come here, Blanca, this is where you measure from. This has to be precise. The form was made of gauze and it had an adhesive back. My breasts were covered with this form in the shape of a cone and then Blanca painted super glue over the form until it became as hard as a rock. I was stunned. I was told I would have a “splint” when I left, not that I would have an iron bra. I was also told that I could not shower. And Blanca said to come back in three weeks when it became loose to have a new one put on. I live 250 miles from Miami and was never told about this before. Blanca also removed the pain pump that had been placed in my chest at surgery. I had worn underwear to the appointment and Blanca was shocked and said didn’t you read the pamphlet, you can’t wear elastic, you will put a dent in your stomach and it will make K angry because he will have to fix it. He is a perfectionist. Sure enough K came into the room and looked at my stomach and said “what is that” and I said it’s from my underwear. He cautioned me not to do this. Later Blanca said you were lucky, he was nice to you about the underwear mark. I remember feeling so off balance about that. What was he going to do, scream at me? The ride home from Miami was torture. Even with the pain meds, I was in excruciating pain in my back and breasts. I went home and went to bed but could not get comfortable. The pain in the center of my back was terrible and I wondered why I would have pain in the center of my back. Both breasts were painful and the iron bra or "splint" as they call it made it impossible to sleep. 8/22 - 8/29 These were basically lost days. I laid in bed only getting up to use the bathroom and eat, though I had no appetite. I could not read, watch TV or use my laptop. I was in a lot of pain and discomfort and could not concentrate. I still could not wear underwear or clothes because my whole lumbar area was so sore and warm to the touch. The recovery from mastectomy was not this bad. 8/29 Contacted Blanca by phone about removing the splint as my skin felt like it was tearing every time I moved and my breasts were painful. She replied by phone stating I should leave them on as long as possible, that’s what Dr. Khouri wants. She suggested wearing a bra over the splints. She said if I decided to remove them I should get in the shower and pour baby oil or olive oil down the front and peel them off. I wondered how I would know if I had an infection with the iron bra completely covering my breasts. 9/1 I sent email to Blanca telling her that I had removed the “splints” per instructions with shower and olive oil. It was extremely painful peeling the splints off. I also told Blanca that I had been experiencing intense itching across the mid to lower back. I asked if it could possibly be an allergic reaction. Blanca replied by email to my email stating I had removed the splints. She did not address the itching. I was still in intense discomfort and pain and was moving from my bed to the couch. I had not left the house, not even to walk to the mailbox. I usually bounce back quickly. I was unable to concentrate. I also was having trouble sleeping even though that’s all I really wanted to do. I was exhausted. 9/3 The itching was so intense it was making me cry. I had tried everything I could think of to alleviate the itching. My husband looked at my back and saw that I had a rash covering my entire back. I emailed Blanca and sent a picture of the rash asking again if it was an allergic reaction. She replied by email stating it wasn’t an allergic reaction to anything they had done. She suggested Benadryl. 9/5 My itching and misery were intense. I kept telling myself to get out of bed and get moving. I tried dusting and could not do it. I was wearing a bra 24/7 per instructions of Blanca and when I went to get in the shower at night, I noticed the lower part of my right breast was red. 9/6 I got up and checked my breast. It was bright red and hot. I immediately emailed Blanca pics and asked what to do. She answered by telephone stating it was an infection. She never mentioned cellulitis or abscess or going to the ER. She prescribed an antibiotic sulphamethtrimethoprim. It was past 9, so we had to find a 24-hour pharmacy. My husband drove to the pharmacy to get it. She also wanted me to take 3 to 5 warm showers lasting 15 minutes each to get the blood flowing. 9/7 The breast was red and the redness was spreading and very warm to the touch. Blanca called to tell me she had spoken to Dr. Khouri who had just landed in New York. He was fleeing the impending hurricane Irma. She said he wanted me to add another antibiotic Cipro and take 5 15-minute warm showers. I wanted the prescription called into our local pharmacy but Blanca called it into the 24-hour pharmacy that we had used the night before. We tracked it down and my husband drove the half hour to get the script so I could begin taking it immediately. Dr. Khouri also prescribed an antibiotic ointment. 9/8 I emailed Blanca with pictures of my breast. I was worried because the hurricane was coming and I wanted to make sure I didn’t need to go to the ER. She looked at the pics and and said she thought it is getting better but said she was assessing through pics, what did I think. I said my husband said it may look slightly better. I asked what will they do in ER. She replied “They will probably do some blood work and if they are really nice they will give you IV antibiotic or will tell you to go see the doctor that did your surgery.” I was taken aback by this. I replied “The question is is there a need for IV antibiotics. If I were in Miami, would Dr. Khouri want me on IV antibiotics or would the oral be okay?” Blanca replied “The oral would be ok. Dr. Khouri would have send you to the hospital if he thought it was necessary.” So here I was with my right breast red and hot and a hurricane coming and was I being told that I shouldn’t go to the emergency room, that they would only treat me if they were being nice. I was very scared. At 3 p.m. I looked at the breast and it was flaming hot and bright red and purple. We decided to head to the ER at Baptist South. I was afraid I may be trapped in my house and not able to get to the hospital. I was seen in the ER. They ordered an ultrasound and did blood work. They started me on IV vancomycin. I had a reaction called red man’s syndrome. They said it was not an allergic reaction, gave me Benadryl and the reaction stopped. I was so relieved to be in the ER. They diagnosed cellulitis and an abscess and said I would need surgery the next morning to drain the abscess. They tried contacting Dr. Khouri. I was admitted and hooked up to IVs to receive IV vancomycin and clindamycin and pain meds. I slept that night for the first time in a long time and the itching started to subside. 9/9 Baptist South general surgeon came in to see me to tell me he had consulted with my original JAX plastic surgeon, and he was going to drain the abscess. I was taken into surgery and when I got out, the surgeon told me that there was a lot of infection under the skin and around the implant, so he called my original plastic surgeon during surgery and he said to remove the implant. I was taken back to my room in relatively little pain. Later that day I saw what my right breast looked like. It was devastating. It was completely collapsed. You could not even see the nipple. And laying in folds. 9/9 - 9/12 I spent the next four days receiving IV antibiotics and watching hurricane Irma from my hospital window. I only got out of bed to use the bathroom. I was exhausted and happy to be taken care of. 9/12 Discharged on oral antibiotics cipro and clindamycin. Infectious disease doc came in to talk about infection. He said he would talk to me more in the post-op appointment but that they had found something funky in the culture. There was a nurse in the room and I wondered why he didn’t just tell me what it was. 9/13 - 9/18 Home recovering. Very sick from the antibiotics. No appetite. 9/19 Post surgical appointment with original JAX PS. He said I would have to wait months before another surgical procedure. He said I would basically be starting all over again. If I wanted implants, I would have to have tissue expanders. He could possibly do a DIEP flap to make small breasts. I was devastated because I had been in pain and discomfort since the day of mastectomy on May 16. All that suffering for naught. I would have to start over. 9/21 Appointment with infectious disease doctor. He told me that the bacteria that caused my infection was an intestinal bacteria called bacteroides fragilis. He said he had no idea how it had gotten into my breast but that it had been there weeks, not days. He said it was extremely rare to find it in the breast. I was flustered and did not ask a lot of questions. My breasts had been totally covered for 15 days post-op. I felt sickened by this. How did fecal matter get in my chest. The thought of a bacteria from [RS bleep] in my chest sickened and angered me. I am now left with a mangled right breast and a partially reconstructed left breast. As of last Friday, my right breast has what looks like a wire I believe to be from the reverse abdominoplasty poking up into my skin that causes extreme pain when I move. I also can no longer wear the breast forms I got because it hurts so badly. (I recently learned it is a brittle suture). So I have to go out in public one-breasted. My fat grafted area still hurts. I have multiple additional scars both from Dr. Khouri's surgery and the abscess drainage and removal of implant. The past 7 weeks have been some of the hardest weeks of my life. I wish I had never heard the name of Dr. Roger Khouri.

I was diagnosed with breast cancer and had a...

  • 9 Oct 2017
I was diagnosed with breast cancer and had a bilateral mastectomy in May of 2016. In March, 2017, I had a consult with Dr. Khouri about RAFT (reverse abdominoplasty with fat transfer) after failed implant surgery post tissue expanders and exchange due to capsular contracture Grade 4 with constant pain and discomfort. I was looking for an alternative to implants because the likelihood of getting cc again once you have had it is very high. I had previously been told I did not have enough fat for flaps and I wanted to avoid another major surgery. I found Dr. Khouri and his RAFT procedure by searching online. I booked a consult and drove the 250 miles to Miami with my husband. His office is in Key Biscayne. I was immediately taken aback by his unprofessional office. You have to walk in through a dermatology office to get to his office. We were placed in a small exam room, I was instructed to remove all my clothes and was given a gown and we waited for almost 3 hours before Dr. Khouri and nurse came in. Dr. Khouri's examination included him taking at least 100 pics of my naked body while my husband stood and watched. Dr. Khouri then continued talking to me while I stood there naked. I asked for my gown three times and finally walked over and put it on. It was not professional and it was humiliating. Dr. Khouri does not listen to you. He does a lot of talking about how his method is far superior to what others are doing. He said he does not use Alloderm because he hates it, he uses the reverse abdominoplasty, which he described basically as an upper abdominal lift that was no big deal. He never mentioned a metal plate being screwed into your clavicle or that wire (or some other hard material. I have yet to find out what it is) is used to make the "purse string" that will hold your new fat grafted breasts in the right anatomic position, that it will define the fold. He did ask my husband and me what we did for a living. He told us that I would have warm, sensate breasts when he was finished. He told me that I would love the way the rest of my body would look post surgery because he would sculpt it with his fat grafting. He said he would be able to alleviate my pain, that he was going to release nerves, that he would be able to help with the numbness in my arm and down my back and that I would regain sensation in my breasts when he got finished. He said this surgery was minimally invasive and I would need three to four surgeries. At the first surgery he would remove the scarred implants, do the RA and do a lot of fat grafting. And even though I had been told by another PS at a consult that I did not have enough fat to create two breasts, Dr. Khouri said I had plenty of fat, no problem. I am 5'5" and 128 lbs. Dr. Khouri does not give you a chance to talk. When you do ask a question, he answers with a lecture and your question goes unanswered. I am sorry I did not trust my instincts after consult. I am sorry that I did not ask to see the surgical suite which is located right above his office. Dr. Khouri's office worked hard on getting approval from my insurance company. It was denied the first time it was submitted but with suggestions from them, it was approved the second time. The surgery was scheduled quickly after approval. They wanted me to have surgery in two weeks but I was able to do that, so we scheduled the surgery for August 17, 2017, three weeks after insurance approval. My husband and I arrived in Miami on August 16 for appointment with Dr. Khouri to mark me. It was late afternoon after driving 250 miles. The appointment was in Dr. Khouri's hand clinic in Miami. Once again, I felt uneasy about this office. The waiting room was full of people and the office was not clean and very disorganized. We were taken to an exam room that was obviously a dermatology exam room and I was told to remove all my clothes and given a gown. We waited for over an hour. When Dr. Khouri came into the room, he sat on a stool and placed his feet on the large old dermatology chair and kicked it across the room. The chair crashed into the pocket doors and knocked them off their tracks. When it was time to leave the room, we could not get out and my husband got down on his hands and knees and put the doors back on their tracks. Dr. Khouri drew all over my body and once again talked to me while I was standing there naked and I had to ask for my gown. He once again asked my husband and me what we did for a living. I asked him what his plan was in case of emergency during surgery since he operates in a standalone suite. He asked "What do you think will happen?" I said "Well, complications can occur quickly." He seemed annoyed at my questions. He said if I would develop a pneumothorax during surgery, he has a friend at Mercy who would take care of me. He launched into a description of pneumothorax and I told him I knew what it was. He seemed irritated by this. He told me I would not be intubated because he likes to maintain control of the airway. When we got back to our hotel, I questioned the fact that I had not been given an antibacterial wash kit. I wanted to shower, so I called Cindy, the coordinator, and asked her if I could shower. She said absolutely not because of the markings. Cindy changed my surgery time three times that evening. I was told the surgery was going to be two hours. My surgery was finally scheduled for 7 and I was told there was another surgery scheduled for 10. When I arrived at the surgical suite above his office, I went into a small waiting area. A male nurse greeted me and gave me paperwork to fill out. I asked him if I needed to do an antibacterial wash, and he said it wasn't necessary, they would do it before surgery. After filling out my paperwork, a male anesthesiologist came out to greet me. He had not shaved that morning and his eyes were bloodshot. It made me uncomfortable. I told him I was allergic to Demerol and this seemed to baffle him. He said they use Demerol as you are coming out of surgery to keep you from getting the shakes. I explained that during my past surgeries, they were able to avoid using Demerol and I did not get the shakes. I don't remember one more thing until I was in the portico of the hotel and my husband came around to get me out of the car and I started vomiting all over the place. I was humiliated. I have never thrown up after surgery. I've always remembered the events leading up to surgery and the events in the recovery room. The surgery lasted 6.5 hours. My husband was told several times during the surgery that he should leave, go to the beach, go out to lunch. He found this bazaar. Who leaves their loved one during a surgery that was supposed to be two hours and has now gone way past that time. Finally, my husband was called into the recovery room. He said it was not clean. He said I was laying on the table sleeping or still drugged. Shortly after he got there, they dressed me and sent me home. My husband was alarmed. Dr. Khouri never came in to talk to him. Once again, I don't remember a thing about the remainder of that day except that I was so thirsty my husband had to sit beside me with water and a straw because I cold not sit up or use my hands to hold a glass. My breasts were completely bandaged and I was told not to remove them until the postop visit five days later when I was instructed to get in the shower right before the appointment and cut the bandages off, which is exactly what I did. The next five days were agonizing. My lower back across the fat grafted area was extremely warm and painful. The center of my spine hurt so badly I could not sit up. A pain pump had been placed in my chest, so at this time that area was not the problem. I was nauseated and could not eat. I had been instructed to remove the compression garment on my lower body the day after surgery and not put any bandages on that area. The garment was a bloody mess. After removing the garment, blood oozed everywhere. When I got up to go to the bathroom, there was a trail of blood my husband had to wipe up. We thankfully had our own bedding and a couple of beach towels. We covered the bed and every time I got up, the bedding had to be changed because it was soaked in blood. 8/21/17 - Post-op visit with Dr. K and Blanca, his nurse. I have no recollection of traveling to their office. I don’t remember packing to go home that morning. Dr. K once again had me get naked and took a bunch more pics. My husband was in the room and I hated him looking at my battered body. Again, I had to ask to put my gown on when he was talking to me. He said what a great job he did, that they looked great. I asked why the surgery took so long and he said something like there was a lot of work to do. They removed some stitches and staples. They did not have gloves on. Blana and Dr. Khouri started cutting out this form to cover my breasts. I had no idea what they were doing. They were arguing over size, a 7 or a 9. K was like come here, come here, Blanca, this is where you measure from. This has to be precise. The form was made of gauze and it had an adhesive back. My breasts were covered with this form in the shape of a cone and then Blanca painted super glue over the form until it became as hard as a rock. I was stunned. I was told I would have a “splint” when I left, not that I would have an iron bra. I was also told that I could not shower. And Blanca said to come back in three weeks when it became loose to have a new one put on. I live 250 miles from Miami and was never told about this before. Blanca also removed the pain pump that had been placed in my chest at surgery. I had worn underwear to the appointment and Blanca was shocked and said didn’t you read the pamphlet, you can’t wear elastic, you will put a dent in your stomach and it will make K angry because he will have to fix it. He is a perfectionist. Sure enough K came into the room and looked at my stomach and said “what is that” and I said it’s from my underwear. He cautioned me not to do this. Later Blanca said you were lucky, he was nice to you about the underwear mark. I remember feeling so off balance about that. What was he going to do, scream at me? The ride home from Miami was torture. Even with the pain meds, I was in excruciating pain in my back and breasts. I went home and went to bed but could not get comfortable. The pain in the center of my back was terrible and I wondered why I would have pain in the center of my back. Both breasts were painful and the iron bra or "splint" as they call it made it impossible to sleep. 8/22 - 8/29 These were basically lost days. I laid in bed only getting up to use the bathroom and eat, though I had no appetite. I could not read, watch TV or use my laptop. I was in a lot of pain and discomfort and could not concentrate. I still could not wear underwear or clothes because my whole lumbar area was so sore and warm to the touch. The recovery from mastectomy was not this bad. 8/29 Contacted Blanca by phone about removing the splint as my skin felt like it was tearing every time I moved and my breasts were painful. She replied by phone stating I should leave them on as long as possible, that’s what Dr. Khouri wants. She suggested wearing a bra over the splints. She said if I decided to remove them I should get in the shower and pour baby oil or olive oil down the front and peel them off. I wondered how I would know if I had an infection with the iron bra completely covering my breasts. 9/1 I sent email to Blanca telling her that I had removed the “splints” per instructions with shower and olive oil. It was extremely painful peeling the splints off. I also told Blanca that I had been experiencing intense itching across the mid to lower back. I asked if it could possibly be an allergic reaction. Blanca replied by email to my email stating I had removed the splints. She did not address the itching. I was still in intense discomfort and pain and was moving from my bed to the couch. I had not left the house, not even to walk to the mailbox. I usually bounce back quickly. I was unable to concentrate. I also was having trouble sleeping even though that’s all I really wanted to do. I was exhausted. 9/3 The itching was so intense it was making me cry. I had tried everything I could think of to alleviate the itching. My husband looked at my back and saw that I had a rash covering my entire back. I emailed Blanca and sent a picture of the rash asking again if it was an allergic reaction. She replied by email stating it wasn’t an allergic reaction to anything they had done. She suggested Benadryl. 9/5 My itching and misery were intense. I kept telling myself to get out of bed and get moving. I tried dusting and could not do it. I was wearing a bra 24/7 per instructions of Blanca and when I went to get in the shower at night, I noticed the lower part of my right breast was red. 9/6 I got up and checked my breast. It was bright red and hot. I immediately emailed Blanca pics and asked what to do. She answered by telephone stating it was an infection. She never mentioned cellulitis or abscess or going to the ER. She prescribed an antibiotic sulphamethtrimethoprim. It was past 9, so we had to find a 24-hour pharmacy. My husband drove to the pharmacy to get it. She also wanted me to take 3 to 5 warm showers lasting 15 minutes each to get the blood flowing. 9/7 The breast was red and the redness was spreading and very warm to the touch. Blanca called to tell me she had spoken to Dr. Khouri who had just landed in New York. He was fleeing the impending hurricane Irma. She said he wanted me to add another antibiotic Cipro and take 5 15-minute warm showers. I wanted the prescription called into our local pharmacy but Blanca called it into the 24-hour pharmacy that we had used the night before. We tracked it down and my husband drove the half hour to get the script so I could begin taking it immediately. Dr. Khouri also prescribed an antibiotic ointment. 9/8 I emailed Blanca with pictures of my breast. I was worried because the hurricane was coming and I wanted to make sure I didn’t need to go to the ER. She looked at the pics and and said she thought it is getting better but said she was assessing through pics, what did I think. I said my husband said it may look slightly better. I asked what will they do in ER. She replied “They will probably do some blood work and if they are really nice they will give you IV antibiotic or will tell you to go see the doctor that did your surgery.” I was taken aback by this. I replied “The question is is there a need for IV antibiotics. If I were in Miami, would Dr. Khouri want me on IV antibiotics or would the oral be okay?” Blanca replied “The oral would be ok. Dr. Khouri would have send you to the hospital if he thought it was necessary.” So here I was with my right breast red and hot and a hurricane coming and was I being told that I shouldn’t go to the emergency room, that they would only treat me if they were being nice. I was very scared. At 3 p.m. I looked at the breast and it was flaming hot and bright red and purple. We decided to head to the ER at Baptist South. I was afraid I may be trapped in my house and not able to get to the hospital. I was seen in the ER. They ordered an ultrasound and did blood work. They started me on IV vancomycin. I had a reaction called red man’s syndrome. They said it was not an allergic reaction, gave me Benadryl and the reaction stopped. I was so relieved to be in the ER. They diagnosed cellulitis and an abscess and said I would need surgery the next morning to drain the abscess. They tried contacting Dr. Khouri. I was admitted and hooked up to IVs to receive IV vancomycin and clindamycin and pain meds. I slept that night for the first time in a long time and the itching started to subside. 9/9 Baptist South general surgeon came in to see me to tell me he had consulted with my original JAX plastic surgeon, and he was going to drain the abscess. I was taken into surgery and when I got out, the surgeon told me that there was a lot of infection under the skin and around the implant, so he called my original plastic surgeon during surgery and he said to remove the implant. I was taken back to my room in relatively little pain. Later that day I saw what my right breast looked like. It was devastating. It was completely collapsed. You could not even see the nipple. And laying in folds. 9/9 - 9/12 I spent the next four days receiving IV antibiotics and watching hurricane Irma from my hospital window. I only got out of bed to use the bathroom. I was exhausted and happy to be taken care of. 9/12 Discharged on oral antibiotics cipro and clindamycin. Infectious disease doc came in to talk about infection. He said he would talk to me more in the post-op appointment but that they had found something funky in the culture. There was a nurse in the room and I wondered why he didn’t just tell me what it was. 9/13 - 9/18 Home recovering. Very sick from the antibiotics. No appetite. 9/19 Post surgical appointment with original JAX PS. He said I would have to wait months before another surgical procedure. He said I would basically be starting all over again. If I wanted implants, I would have to have tissue expanders. He could possibly do a DIEP flap to make small breasts. I was devastated because I had been in pain and discomfort since the day of mastectomy on May 16. All that suffering for naught. I would have to start over. 9/21 Appointment with infectious disease doctor. He told me that the bacteria that caused my infection was an intestinal bacteria called bacteroides fragilis. He said he had no idea how it had gotten into my breast but that it had been there weeks, not days. He said it was extremely rare to find it in the breast. I was flustered and did not ask a lot of questions. My breasts had been totally covered for 15 days post-op. I felt sickened by this. How did fecal matter get in my chest. The thought of a bacteria from [RS bleep] in my chest sickened and angered me. I am now left with a mangled right breast and a partially reconstructed left breast. As of last Friday, my right breast has what looks like a wire I believe to be from the reverse abdominoplasty poking up into my skin that causes extreme pain when I move. I also can no longer wear the breast forms I got because it hurts so badly. So I have to go out in public one-breasted. My fat grafted area still hurts. I have multiple additional scars both from Dr. Khouri's surgery and the abscess drainage and removal of implant. The past 7 weeks have been some of the hardest weeks of my life. I wish I had never heard the name of Dr. Roger Khouri.

Provider Review

Roger Khouri, MD
Board Certified Plastic Surgeon
580 Crandon Blvd, Key Biscayne, Florida
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Overall rating
  • 9 Oct 2017

I was diagnosed with breast cancer and had a bilateral mastectomy in May of 2016. In March, 2017, I had a consult with Dr. Khouri about RAFT (reverse abdominoplasty with fat transfer) after failed implant surgery post tissue expanders and exchange due to capsular contracture Grade 4 with constant pain and discomfort. I was looking for an alternative to implants because the likelihood of getting cc again once you have had it is very high. I had previously been told I did not have enough fat for flaps and I wanted to avoid another major surgery. I found Dr. Khouri and his RAFT procedure by searching online. I booked a consult and drove the 250 miles to Miami with my husband. His office is in Key Biscayne. I was immediately taken aback by his unprofessional office. You have to walk in through a dermatology office to get to his office. We were placed in a small exam room, I was instructed to remove all my clothes and was given a gown and we waited for almost 3 hours before Dr. Khouri and nurse came in. Dr. Khouri's examination included him taking at least 100 pics of my naked body while my husband stood and watched. Dr. Khouri then continued talking to me while I stood there naked. I asked for my gown three times and finally walked over and put it on. It was not professional and it was humiliating. Dr. Khouri does not listen to you. He does a lot of talking about how his method is far superior to what others are doing. He said he does not use Alloderm because he hates it, he uses the reverse abdominoplasty, which he described basically as an upper abdominal lift that was no big deal. He never mentioned a metal plate being screwed into your clavicle or that wire (or some other hard material. I have yet to find out what it is) is used to make the "purse string" that will hold your new fat grafted breasts in the right anatomic position, that it will define the fold. He did ask my husband and me what we did for a living. He told us that I would have warm, sensate breasts when he was finished. He told me that I would love the way the rest of my body would look post surgery because he would sculpt it with his fat grafting. He said he would be able to alleviate my pain, that he was going to release nerves, that he would be able to help with the numbness in my arm and down my back and that I would regain sensation in my breasts when he got finished. He said this surgery was minimally invasive and I would need three to four surgeries. At the first surgery he would remove the scarred implants, do the RA and do a lot of fat grafting. And even though I had been told by another PS at a consult that I did not have enough fat to create two breasts, Dr. Khouri said I had plenty of fat, no problem. I am 5'5" and 128 lbs. Dr. Khouri does not give you a chance to talk. When you do ask a question, he answers with a lecture and your question goes unanswered. I am sorry I did not trust my instincts after consult. I am sorry that I did not ask to see the surgical suite which is located right above his office. Dr. Khouri's office worked hard on getting approval from my insurance company. It was denied the first time it was submitted but with suggestions from them, it was approved the second time. The surgery was scheduled quickly after approval. They wanted me to have surgery in two weeks but I was able to do that, so we scheduled the surgery for August 17, 2017, three weeks after insurance approval. My husband and I arrived in Miami on August 16 for appointment with Dr. Khouri to mark me. It was late afternoon after driving 250 miles. The appointment was in Dr. Khouri's hand clinic in Miami. Once again, I felt uneasy about this office. The waiting room was full of people and the office was not clean and very disorganized. We were taken to an exam room that was obviously a dermatology exam room and I was told to remove all my clothes and given a gown. We waited for over an hour. When Dr. Khouri came into the room, he sat on a stool and placed his feet on the large old dermatology chair and kicked it across the room. The chair crashed into the pocket doors and knocked them off their tracks. When it was time to leave the room, we could not get out and my husband got down on his hands and knees and put the doors back on their tracks. Dr. Khouri drew all over my body and once again talked to me while I was standing there naked and I had to ask for my gown. He once again asked my husband and me what we did for a living. I asked him what his plan was in case of emergency during surgery since he operates in a standalone suite. He asked "What do you think will happen?" I said "Well, complications can occur quickly." He seemed annoyed at my questions. He said if I would develop a pneumothorax during surgery, he has a friend at Mercy who would take care of me. He launched into a description of pneumothorax and I told him I knew what it was. He seemed irritated by this. He told me I would not be intubated because he likes to maintain control of the airway. When we got back to our hotel, I questioned the fact that I had not been given an antibacterial wash kit. I wanted to shower, so I called Cindy, the coordinator, and asked her if I could shower. She said absolutely not because of the markings. Cindy changed my surgery time three times that evening. I was told the surgery was going to be two hours. My surgery was finally scheduled for 7 and I was told there was another surgery scheduled for 10. When I arrived at the surgical suite above his office, I went into a small waiting area. A male nurse greeted me and gave me paperwork to fill out. I asked him if I needed to do an antibacterial wash, and he said it wasn't necessary, they would do it before surgery. After filling out my paperwork, a male anesthesiologist came out to greet me. He had not shaved that morning and his eyes were bloodshot. It made me uncomfortable. I told him I was allergic to Demerol and this seemed to baffle him. He said they use Demerol as you are coming out of surgery to keep you from getting the shakes. I explained that during my past surgeries, they were able to avoid using Demerol and I did not get the shakes. I don't remember one more thing until I was in the portico of the hotel and my husband came around to get me out of the car and I started vomiting all over the place. I was humiliated. I have never thrown up after surgery. I've always remembered the events leading up to surgery and the events in the recovery room. The surgery lasted 6.5 hours. My husband was told several times during the surgery that he should leave, go to the beach, go out to lunch. He found this bazaar. Who leaves their loved one during a surgery that was supposed to be two hours and has now gone way past that time. Finally, my husband was called into the recovery room. He said it was not clean. He said I was laying on the table sleeping or still drugged. Shortly after he got there, they dressed me and sent me home. My husband was alarmed. Dr. Khouri never came in to talk to him. Once again, I don't remember a thing about the remainder of that day except that I was so thirsty my husband had to sit beside me with water and a straw because I cold not sit up or use my hands to hold a glass. My breasts were completely bandaged and I was told not to remove them until the postop visit five days later when I was instructed to get in the shower right before the appointment and cut the bandages off, which is exactly what I did. The next five days were agonizing. My lower back across the fat grafted area was extremely warm and painful. The center of my spine hurt so badly I could not sit up. A pain pump had been placed in my chest, so at this time that area was not the problem. I was nauseated and could not eat. I had been instructed to remove the compression garment on my lower body the day after surgery and not put any bandages on that area. The garment was a bloody mess. After removing the garment, blood oozed everywhere. When I got up to go to the bathroom, there was a trail of blood my husband had to wipe up. We thankfully had our own bedding and a couple of beach towels. We covered the bed and every time I got up, the bedding had to be changed because it was soaked in blood. 8/21/17 - Post-op visit with Dr. K and Blanca, his nurse. I have no recollection of traveling to their office. I don’t remember packing to go home that morning. Dr. K once again had me get naked and took a bunch more pics. My husband was in the room and I hated him looking at my battered body. Again, I had to ask to put my gown on when he was talking to me. He said what a great job he did, that they looked great. I asked why the surgery took so long and he said something like there was a lot of work to do. They removed some stitches and staples. They did not have gloves on. Blana and Dr. Khouri started cutting out this form to cover my breasts. I had no idea what they were doing. They were arguing over size, a 7 or a 9. K was like come here, come here, Blanca, this is where you measure from. This has to be precise. The form was made of gauze and it had an adhesive back. My breasts were covered with this form in the shape of a cone and then Blanca painted super glue over the form until it became as hard as a rock. I was stunned. I was told I would have a “splint” when I left, not that I would have an iron bra. I was also told that I could not shower. And Blanca said to come back in three weeks when it became loose to have a new one put on. I live 250 miles from Miami and was never told about this before. Blanca also removed the pain pump that had been placed in my chest at surgery. I had worn underwear to the appointment and Blanca was shocked and said didn’t you read the pamphlet, you can’t wear elastic, you will put a dent in your stomach and it will make K angry because he will have to fix it. He is a perfectionist. Sure enough K came into the room and looked at my stomach and said “what is that” and I said it’s from my underwear. He cautioned me not to do this. Later Blanca said you were lucky, he was nice to you about the underwear mark. I remember feeling so off balance about that. What was he going to do, scream at me? The ride home from Miami was torture. Even with the pain meds, I was in excruciating pain in my back and breasts. I went home and went to bed but could not get comfortable. The pain in the center of my back was terrible and I wondered why I would have pain in the center of my back. Both breasts were painful and the iron bra or "splint" as they call it made it impossible to sleep. 8/22 - 8/29 These were basically lost days. I laid in bed only getting up to use the bathroom and eat, though I had no appetite. I could not read, watch TV or use my laptop. I was in a lot of pain and discomfort and could not concentrate. I still could not wear underwear or clothes because my whole lumbar area was so sore and warm to the touch. The recovery from mastectomy was not this bad. 8/29 Contacted Blanca by phone about removing the splint as my skin felt like it was tearing every time I moved and my breasts were painful. She replied by phone stating I should leave them on as long as possible, that’s what Dr. Khouri wants. She suggested wearing a bra over the splints. She said if I decided to remove them I should get in the shower and pour baby oil or olive oil down the front and peel them off. I wondered how I would know if I had an infection with the iron bra completely covering my breasts. 9/1 I sent email to Blanca telling her that I had removed the “splints” per instructions with shower and olive oil. It was extremely painful peeling the splints off. I also told Blanca that I had been experiencing intense itching across the mid to lower back. I asked if it could possibly be an allergic reaction. Blanca replied by email to my email stating I had removed the splints. She did not address the itching. I was still in intense discomfort and pain and was moving from my bed to the couch. I had not left the house, not even to walk to the mailbox. I usually bounce back quickly. I was unable to concentrate. I also was having trouble sleeping even though that’s all I really wanted to do. I was exhausted. 9/3 The itching was so intense it was making me cry. I had tried everything I could think of to alleviate the itching. My husband looked at my back and saw that I had a rash covering my entire back. I emailed Blanca and sent a picture of the rash asking again if it was an allergic reaction. She replied by email stating it wasn’t an allergic reaction to anything they had done. She suggested Benadryl. 9/5 My itching and misery were intense. I kept telling myself to get out of bed and get moving. I tried dusting and could not do it. I was wearing a bra 24/7 per instructions of Blanca and when I went to get in the shower at night, I noticed the lower part of my right breast was red. 9/6 I got up and checked my breast. It was bright red and hot. I immediately emailed Blanca pics and asked what to do. She answered by telephone stating it was an infection. She never mentioned cellulitis or abscess or going to the ER. She prescribed an antibiotic sulphamethtrimethoprim. It was past 9, so we had to find a 24-hour pharmacy. My husband drove to the pharmacy to get it. She also wanted me to take 3 to 5 warm showers lasting 15 minutes each to get the blood flowing. 9/7 The breast was red and the redness was spreading and very warm to the touch. Blanca called to tell me she had spoken to Dr. Khouri who had just landed in New York. He was fleeing the impending hurricane Irma. She said he wanted me to add another antibiotic Cipro and take 5 15-minute warm showers. I wanted the prescription called into our local pharmacy but Blanca called it into the 24-hour pharmacy that we had used the night before. We tracked it down and my husband drove the half hour to get the script so I could begin taking it immediately. Dr. Khouri also prescribed an antibiotic ointment. 9/8 I emailed Blanca with pictures of my breast. I was worried because the hurricane was coming and I wanted to make sure I didn’t need to go to the ER. She looked at the pics and and said she thought it is getting better but said she was assessing through pics, what did I think. I said my husband said it may look slightly better. I asked what will they do in ER. She replied “They will probably do some blood work and if they are really nice they will give you IV antibiotic or will tell you to go see the doctor that did your surgery.” I was taken aback by this. I replied “The question is is there a need for IV antibiotics. If I were in Miami, would Dr. Khouri want me on IV antibiotics or would the oral be okay?” Blanca replied “The oral would be ok. Dr. Khouri would have send you to the hospital if he thought it was necessary.” So here I was with my right breast red and hot and a hurricane coming and was I being told that I shouldn’t go to the emergency room, that they would only treat me if they were being nice. I was very scared. At 3 p.m. I looked at the breast and it was flaming hot and bright red and purple. We decided to head to the ER at Baptist South. I was afraid I may be trapped in my house and not able to get to the hospital. I was seen in the ER. They ordered an ultrasound and did blood work. They started me on IV vancomycin. I had a reaction called red man’s syndrome. They said it was not an allergic reaction, gave me Benadryl and the reaction stopped. I was so relieved to be in the ER. They diagnosed cellulitis and an abscess and said I would need surgery the next morning to drain the abscess. They tried contacting Dr. Khouri. I was admitted and hooked up to IVs to receive IV vancomycin and clindamycin and pain meds. I slept that night for the first time in a long time and the itching started to subside. 9/9 Baptist South general surgeon came in to see me to tell me he had consulted with my original JAX plastic surgeon, and he was going to drain the abscess. I was taken into surgery and when I got out, the surgeon told me that there was a lot of infection under the skin and around the implant, so he called my original plastic surgeon during surgery and he said to remove the implant. I was taken back to my room in relatively little pain. Later that day I saw what my right breast looked like. It was devastating. It was completely collapsed. You could not even see the nipple. And laying in folds. 9/9 - 9/12 I spent the next four days receiving IV antibiotics and watching hurricane Irma from my hospital window. I only got out of bed to use the bathroom. I was exhausted and happy to be taken care of. 9/12 Discharged on oral antibiotics cipro and clindamycin. Infectious disease doc came in to talk about infection. He said he would talk to me more in the post-op appointment but that they had found something funky in the culture. There was a nurse in the room and I wondered why he didn’t just tell me what it was. 9/13 - 9/18 Home recovering. Very sick from the antibiotics. No appetite. 9/19 Post surgical appointment with original JAX PS. He said I would have to wait months before another surgical procedure. He said I would basically be starting all over again. If I wanted implants, I would have to have tissue expanders. He could possibly do a DIEP flap to make small breasts. I was devastated because I had been in pain and discomfort since the day of mastectomy on May 16. All that suffering for naught. I would have to start over. 9/21 Appointment with infectious disease doctor. He told me that the bacteria that caused my infection was an intestinal bacteria called bacteroides fragilis. He said he had no idea how it had gotten into my breast but that it had been there weeks, not days. He said it was extremely rare to find it in the breast. I was flustered and did not ask a lot of questions. My breasts had been totally covered for 15 days post-op. I felt sickened by this. How did fecal matter get in my chest. The thought of a bacteria from [RS bleep] in my chest sickened and angered me. I am now left with a mangled right breast and a partially reconstructed left breast. As of last Friday, my right breast has what looks like a wire I believe to be from the reverse abdominoplasty poking up into my skin that causes extreme pain when I move. I also can no longer wear the breast forms I got because it hurts so badly. So I have to go out in public one-breasted. My fat grafted area still hurts. I have multiple additional scars both from Dr. Khouri's surgery and the abscess drainage and removal of implant. The past 7 weeks have been some of the hardest weeks of my life. I wish I had never heard the name of Dr. Roger Khouri.

Updated on 18 Oct 2017:
I was diagnosed with breast cancer and had a bilateral mastectomy in May of 2016. In March, 2017, I had a consult with Dr. Khouri about RAFT (reverse abdominoplasty with fat transfer) after failed implant surgery post tissue expanders and exchange due to capsular contracture Grade 4 with constant pain and discomfort. I was looking for an alternative to implants because the likelihood of getting cc again once you have had it is very high. I had previously been told I did not have enough fat for flaps and I wanted to avoid another major surgery. I found Dr. Khouri and his RAFT procedure by searching online. I booked a consult and drove the 250 miles to Miami with my husband. His office is in Key Biscayne. I was immediately taken aback by his unprofessional office. You have to walk in through a dermatology office to get to his office. We were placed in a small exam room, I was instructed to remove all my clothes and was given a gown and we waited for almost 3 hours before Dr. Khouri and nurse came in. Dr. Khouri's examination included him taking at least 100 pics of my naked body while my husband stood and watched. Dr. Khouri then continued talking to me while I stood there naked. I asked for my gown three times and finally walked over and put it on. It was not professional and it was humiliating. Dr. Khouri does not listen to you. He does a lot of talking about how his method is far superior to what others are doing. He said he does not use Alloderm because he hates it, he uses the reverse abdominoplasty, which he described basically as an upper abdominal lift that was no big deal. He never mentioned a metal plate being screwed into your clavicle or that wire (or some other hard material. I have yet to find out what it is) is used to make the "purse string" that will hold your new fat grafted breasts in the right anatomic position, that it will define the fold. He did ask my husband and me what we did for a living. He told us that I would have warm, sensate breasts when he was finished. He told me that I would love the way the rest of my body would look post surgery because he would sculpt it with his fat grafting. He said he would be able to alleviate my pain, that he was going to release nerves, that he would be able to help with the numbness in my arm and down my back and that I would regain sensation in my breasts when he got finished. He said this surgery was minimally invasive and I would need three to four surgeries. At the first surgery he would remove the scarred implants, do the RA and do a lot of fat grafting. And even though I had been told by another PS at a consult that I did not have enough fat to create two breasts, Dr. Khouri said I had plenty of fat, no problem. I am 5'5" and 128 lbs. Dr. Khouri does not give you a chance to talk. When you do ask a question, he answers with a lecture and your question goes unanswered. I am sorry I did not trust my instincts after consult. I am sorry that I did not ask to see the surgical suite which is located right above his office. Dr. Khouri's office worked hard on getting approval from my insurance company. It was denied the first time it was submitted but with suggestions from them, it was approved the second time. The surgery was scheduled quickly after approval. They wanted me to have surgery in two weeks but I was able to do that, so we scheduled the surgery for August 17, 2017, three weeks after insurance approval. My husband and I arrived in Miami on August 16 for appointment with Dr. Khouri to mark me. It was late afternoon after driving 250 miles. The appointment was in Dr. Khouri's hand clinic in Miami. Once again, I felt uneasy about this office. The waiting room was full of people and the office was not clean and very disorganized. We were taken to an exam room that was obviously a dermatology exam room and I was told to remove all my clothes and given a gown. We waited for over an hour. When Dr. Khouri came into the room, he sat on a stool and placed his feet on the large old dermatology chair and kicked it across the room. The chair crashed into the pocket doors and knocked them off their tracks. When it was time to leave the room, we could not get out and my husband got down on his hands and knees and put the doors back on their tracks. Dr. Khouri drew all over my body and once again talked to me while I was standing there naked and I had to ask for my gown. He once again asked my husband and me what we did for a living. I asked him what his plan was in case of emergency during surgery since he operates in a standalone suite. He asked "What do you think will happen?" I said "Well, complications can occur quickly." He seemed annoyed at my questions. He said if I would develop a pneumothorax during surgery, he has a friend at Mercy who would take care of me. He launched into a description of pneumothorax and I told him I knew what it was. He seemed irritated by this. He told me I would not be intubated because he likes to maintain control of the airway. When we got back to our hotel, I questioned the fact that I had not been given an antibacterial wash kit. I wanted to shower, so I called Cindy, the coordinator, and asked her if I could shower. She said absolutely not because of the markings. Cindy changed my surgery time three times that evening. I was told the surgery was going to be two hours. My surgery was finally scheduled for 7 and I was told there was another surgery scheduled for 10. When I arrived at the surgical suite above his office, I went into a small waiting area. A male nurse greeted me and gave me paperwork to fill out. I asked him if I needed to do an antibacterial wash, and he said it wasn't necessary, they would do it before surgery. After filling out my paperwork, a male anesthesiologist came out to greet me. He had not shaved that morning and his eyes were bloodshot. It made me uncomfortable. I told him I was allergic to Demerol and this seemed to baffle him. He said they use Demerol as you are coming out of surgery to keep you from getting the shakes. I explained that during my past surgeries, they were able to avoid using Demerol and I did not get the shakes. I don't remember one more thing until I was in the portico of the hotel and my husband came around to get me out of the car and I started vomiting all over the place. I was humiliated. I have never thrown up after surgery. I've always remembered the events leading up to surgery and the events in the recovery room. The surgery lasted 6.5 hours. My husband was told several times during the surgery that he should leave, go to the beach, go out to lunch. He found this bazaar. Who leaves their loved one during a surgery that was supposed to be two hours and has now gone way past that time. Finally, my husband was called into the recovery room. He said it was not clean. He said I was laying on the table sleeping or still drugged. Shortly after he got there, they dressed me and sent me home. My husband was alarmed. Dr. Khouri never came in to talk to him. Once again, I don't remember a thing about the remainder of that day except that I was so thirsty my husband had to sit beside me with water and a straw because I cold not sit up or use my hands to hold a glass. My breasts were completely bandaged and I was told not to remove them until the postop visit five days later when I was instructed to get in the shower right before the appointment and cut the bandages off, which is exactly what I did. The next five days were agonizing. My lower back across the fat grafted area was extremely warm and painful. The center of my spine hurt so badly I could not sit up. A pain pump had been placed in my chest, so at this time that area was not the problem. I was nauseated and could not eat. I had been instructed to remove the compression garment on my lower body the day after surgery and not put any bandages on that area. The garment was a bloody mess. After removing the garment, blood oozed everywhere. When I got up to go to the bathroom, there was a trail of blood my husband had to wipe up. We thankfully had our own bedding and a couple of beach towels. We covered the bed and every time I got up, the bedding had to be changed because it was soaked in blood. 8/21/17 - Post-op visit with Dr. K and Blanca, his nurse. I have no recollection of traveling to their office. I don’t remember packing to go home that morning. Dr. K once again had me get naked and took a bunch more pics. My husband was in the room and I hated him looking at my battered body. Again, I had to ask to put my gown on when he was talking to me. He said what a great job he did, that they looked great. I asked why the surgery took so long and he said something like there was a lot of work to do. They removed some stitches and staples. They did not have gloves on. Blana and Dr. Khouri started cutting out this form to cover my breasts. I had no idea what they were doing. They were arguing over size, a 7 or a 9. K was like come here, come here, Blanca, this is where you measure from. This has to be precise. The form was made of gauze and it had an adhesive back. My breasts were covered with this form in the shape of a cone and then Blanca painted super glue over the form until it became as hard as a rock. I was stunned. I was told I would have a “splint” when I left, not that I would have an iron bra. I was also told that I could not shower. And Blanca said to come back in three weeks when it became loose to have a new one put on. I live 250 miles from Miami and was never told about this before. Blanca also removed the pain pump that had been placed in my chest at surgery. I had worn underwear to the appointment and Blanca was shocked and said didn’t you read the pamphlet, you can’t wear elastic, you will put a dent in your stomach and it will make K angry because he will have to fix it. He is a perfectionist. Sure enough K came into the room and looked at my stomach and said “what is that” and I said it’s from my underwear. He cautioned me not to do this. Later Blanca said you were lucky, he was nice to you about the underwear mark. I remember feeling so off balance about that. What was he going to do, scream at me? The ride home from Miami was torture. Even with the pain meds, I was in excruciating pain in my back and breasts. I went home and went to bed but could not get comfortable. The pain in the center of my back was terrible and I wondered why I would have pain in the center of my back. Both breasts were painful and the iron bra or "splint" as they call it made it impossible to sleep. 8/22 - 8/29 These were basically lost days. I laid in bed only getting up to use the bathroom and eat, though I had no appetite. I could not read, watch TV or use my laptop. I was in a lot of pain and discomfort and could not concentrate. I still could not wear underwear or clothes because my whole lumbar area was so sore and warm to the touch. The recovery from mastectomy was not this bad. 8/29 Contacted Blanca by phone about removing the splint as my skin felt like it was tearing every time I moved and my breasts were painful. She replied by phone stating I should leave them on as long as possible, that’s what Dr. Khouri wants. She suggested wearing a bra over the splints. She said if I decided to remove them I should get in the shower and pour baby oil or olive oil down the front and peel them off. I wondered how I would know if I had an infection with the iron bra completely covering my breasts. 9/1 I sent email to Blanca telling her that I had removed the “splints” per instructions with shower and olive oil. It was extremely painful peeling the splints off. I also told Blanca that I had been experiencing intense itching across the mid to lower back. I asked if it could possibly be an allergic reaction. Blanca replied by email to my email stating I had removed the splints. She did not address the itching. I was still in intense discomfort and pain and was moving from my bed to the couch. I had not left the house, not even to walk to the mailbox. I usually bounce back quickly. I was unable to concentrate. I also was having trouble sleeping even though that’s all I really wanted to do. I was exhausted. 9/3 The itching was so intense it was making me cry. I had tried everything I could think of to alleviate the itching. My husband looked at my back and saw that I had a rash covering my entire back. I emailed Blanca and sent a picture of the rash asking again if it was an allergic reaction. She replied by email stating it wasn’t an allergic reaction to anything they had done. She suggested Benadryl. 9/5 My itching and misery were intense. I kept telling myself to get out of bed and get moving. I tried dusting and could not do it. I was wearing a bra 24/7 per instructions of Blanca and when I went to get in the shower at night, I noticed the lower part of my right breast was red. 9/6 I got up and checked my breast. It was bright red and hot. I immediately emailed Blanca pics and asked what to do. She answered by telephone stating it was an infection. She never mentioned cellulitis or abscess or going to the ER. She prescribed an antibiotic sulphamethtrimethoprim. It was past 9, so we had to find a 24-hour pharmacy. My husband drove to the pharmacy to get it. She also wanted me to take 3 to 5 warm showers lasting 15 minutes each to get the blood flowing. 9/7 The breast was red and the redness was spreading and very warm to the touch. Blanca called to tell me she had spoken to Dr. Khouri who had just landed in New York. He was fleeing the impending hurricane Irma. She said he wanted me to add another antibiotic Cipro and take 5 15-minute warm showers. I wanted the prescription called into our local pharmacy but Blanca called it into the 24-hour pharmacy that we had used the night before. We tracked it down and my husband drove the half hour to get the script so I could begin taking it immediately. Dr. Khouri also prescribed an antibiotic ointment. 9/8 I emailed Blanca with pictures of my breast. I was worried because the hurricane was coming and I wanted to make sure I didn’t need to go to the ER. She looked at the pics and and said she thought it is getting better but said she was assessing through pics, what did I think. I said my husband said it may look slightly better. I asked what will they do in ER. She replied “They will probably do some blood work and if they are really nice they will give you IV antibiotic or will tell you to go see the doctor that did your surgery.” I was taken aback by this. I replied “The question is is there a need for IV antibiotics. If I were in Miami, would Dr. Khouri want me on IV antibiotics or would the oral be okay?” Blanca replied “The oral would be ok. Dr. Khouri would have send you to the hospital if he thought it was necessary.” So here I was with my right breast red and hot and a hurricane coming and was I being told that I shouldn’t go to the emergency room, that they would only treat me if they were being nice. I was very scared. At 3 p.m. I looked at the breast and it was flaming hot and bright red and purple. We decided to head to the ER at Baptist South. I was afraid I may be trapped in my house and not able to get to the hospital. I was seen in the ER. They ordered an ultrasound and did blood work. They started me on IV vancomycin. I had a reaction called red man’s syndrome. They said it was not an allergic reaction, gave me Benadryl and the reaction stopped. I was so relieved to be in the ER. They diagnosed cellulitis and an abscess and said I would need surgery the next morning to drain the abscess. They tried contacting Dr. Khouri. I was admitted and hooked up to IVs to receive IV vancomycin and clindamycin and pain meds. I slept that night for the first time in a long time and the itching started to subside. 9/9 Baptist South general surgeon came in to see me to tell me he had consulted with my original JAX plastic surgeon, and he was going to drain the abscess. I was taken into surgery and when I got out, the surgeon told me that there was a lot of infection under the skin and around the implant, so he called my original plastic surgeon during surgery and he said to remove the implant. I was taken back to my room in relatively little pain. Later that day I saw what my right breast looked like. It was devastating. It was completely collapsed. You could not even see the nipple. And laying in folds. 9/9 - 9/12 I spent the next four days receiving IV antibiotics and watching hurricane Irma from my hospital window. I only got out of bed to use the bathroom. I was exhausted and happy to be taken care of. 9/12 Discharged on oral antibiotics cipro and clindamycin. Infectious disease doc came in to talk about infection. He said he would talk to me more in the post-op appointment but that they had found something funky in the culture. There was a nurse in the room and I wondered why he didn’t just tell me what it was. 9/13 - 9/18 Home recovering. Very sick from the antibiotics. No appetite. 9/19 Post surgical appointment with original JAX PS. He said I would have to wait months before another surgical procedure. He said I would basically be starting all over again. If I wanted implants, I would have to have tissue expanders. He could possibly do a DIEP flap to make small breasts. I was devastated because I had been in pain and discomfort since the day of mastectomy on May 16. All that suffering for naught. I would have to start over. 9/21 Appointment with infectious disease doctor. He told me that the bacteria that caused my infection was an intestinal bacteria called bacteroides fragilis. He said he had no idea how it had gotten into my breast but that it had been there weeks, not days. He said it was extremely rare to find it in the breast. I was flustered and did not ask a lot of questions. My breasts had been totally covered for 15 days post-op. I felt sickened by this. How did fecal matter get in my chest. The thought of a bacteria from [RS bleep] in my chest sickened and angered me. I am now left with a mangled right breast and a partially reconstructed left breast. As of last Friday, my right breast has what looks like a wire I believe to be from the reverse abdominoplasty poking up into my skin that causes extreme pain when I move. I also can no longer wear the breast forms I got because it hurts so badly. (I recently learned it is a brittle suture). So I have to go out in public one-breasted. My fat grafted area still hurts. I have multiple additional scars both from Dr. Khouri's surgery and the abscess drainage and removal of implant. The past 7 weeks have been some of the hardest weeks of my life. I wish I had never heard the name of Dr. Roger Khouri.