I love science.
This month’s May 2012 issue of Plastic and Reconstructive Surgery Journal has an article which I like. “Brava and Autologous Fat Transfer Is a Safe and Effective Breast Augmentation Alternative; Results of a 6 year, 81 patient, Prospective Multicenter Study.” This is a study by Dr. Khouri with other Plastic Surgeons from around the world. The quick synopsis:
- 81 patients
- Patients were non smokers; must do BRAVA system pre (4 weeks) and post (1-4 weeks) surgery; average BMI 19.8; age range 17-63
- MRI presurgery
- Post-surgery MRI at 6 months to document the volume change
- Follow up range 12 months to 6 years
- These patients were compared to NON BRAVA fat grafting patients
FINDINGS:
- MRI showed no changes between 3 months and 6 months. (ie what they had at 3 months stayed)
- 71 patients were compliant with BRAVA– mean augmentation at 1 year was 233cc per breast, with graft survival of 82% +/- 18%
- Patients who did fat transfer without BRAVA has 134cc per breast, and 55% fat survival +/- 18%
- No suspicious breast masses or nodules were found.
- MRI saw a 16% incidence of fat necrosis easily identified at the 1 year mammogram
So the conclusion? The addition of BRAVA expansion before fat grafting allowed significantly larger breast augmentations, with more fat surviving and minimal necrosis or complications. They found a strong linear correlation between how big you got before surgery with BRAVA (“pregrafting BRAVA expansion”) and what you see for your actual fat graft breast augmentation results.
I was glad to see this. I started doing fat grafting breast augmentations and assist to my breast cancer reconstructions almost a year ago. I am thrilled with what I have seen so far, and I have patients who are over 6 months out. But BRAVA can be a pain to wear. It does not always go easy. So the question lingering in my mind—do you really need the BRAVA? I knew I needed it for my young patients who have tight skin. Young patients are easy- they need BRAVA because they haven’t had gravity, pregnancies, and breastfeeding stretch things out yet. When you have tight skin, you must stretch out the skin envelope to allow room for the fat grafting- otherwise the tension on the fat is too much, and it kills the fat.
But for those with loose skin….. Do you need BRAVA? This study shows in a prospective, multicenter trial with pre and post op MRI volumetric analysis at 6 months, there is a lasting increase in breast volume. This increase is more than those done without the BRAVA system.
For those who want to see the study, I have reprints in my office. As you know, I trained with Dr. Khouri last summer to learn his technique. I am glad to see this paper come out. For the right patient, I am increasingly a fan of fat grafting.