Fat transfer to the breast is on the rise, and journal articles are appearing more frequently. For those of you who have had a consultation with me or are following my blog, most of this information will be a recap. But as always, I am reading our new studies to try to improve on what we are able to do.
“Aesthetic applications of BRAVA assisted Megavolume Fat Grafting to the Breasts: A 9 year, 476 Patient, Multicenter Experience.” By Dr. Khouri appeared in the April 2014 Plastic and Reconstructive Surgery Journal.
Review:
- The patients were a mix of aesthetic cosmetic breast augmentation, congenital deformities, and implant to fat conversion (removing a current implant and replacing with fat transfer)
- Follow up ranged from 6 months to 9 years
- The mean amount transferred was 346cc
- The mean amount present at 6 months postop was 266 cc
- No patients required open biopsy or were diagnosed with cancer
- The study was from 2004 – 2013
- Patient range in age 16-60 years
- BMI 16.2-29.2, mean 21.6
- exclusion criteria: smoking, prolonged bleeding, unrealistic expectations, and multiple previous liposuction procedures.
Pearls from the article:
- Patient compliance with BRAVA is essential and you must OVER expand. They must triple their volume to obtain a final volume of double their original volume.
- He feels BRAVA causes increased capillary density. (more blood flow = better for fat survival)
- For congenital bands (constricted breast, tubular breast, etc) BRAVA does not release the bands, it loosens them. Because the vacuum will expand along the path of least resistance, the deformity is temporarily worsened. To release this tightness, we use a mesh release pattern and then fill with fat.
- For patients who are having implant removal done, the case is a little different- the skin is already expanded. He feels the capsule around the implant caused increased blood flow in the tissue already. BRAVA is not used for patients with current implants. If the implant is over 300cc, a 2 stage procedure may need to be done with placement of a small implant at the first stage, total removal at the second.
- Comparing BRAVA retention rate vs. fat transfer without BRAVA: he had 293cc mean augmetntion, 79% retention rate, vs 134 cc mean augmentation, 54% survival without BRAVA
- There was lower graft retention for implant to fat conversion patients (he thinks this is due to the deflated recipient site, “not as suitable for nurturing grafts as a large, edematous, well vascularized pre expanded breast.”)
- The false positive rate on post op MRI screenings was 4.4%, which is similar to the false positive rate of breast MRI screenings in general (4.9%), but it is crucial to not dismiss any palpable mass as fat necrosis without radiographic confirmation.
Complications:
- Localized foci of fat necrosis 19%
- Small palpable nodules in 15% of patients
- Asian and Aftican women often developed post inflammatory hyperpigmentation from the BRAVA use which eventually cleared wtih hydroquinone creams
- When the mesh needle release was done, immediate postop BRAVA caused small milia like skin lesions. They have since stopped using BRAVA postop when they perfom many Rigottomies.
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
