Pre-operative expansion of the breast followed by injection of the patient's own fat provides a safe and effective alternative to implant surgery for breast augmentation, reports a study in the May issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS). The technique, which includes using a special suction-pump bra device for a few weeks before surgery to "pre-expand" the breasts, provides greater augmentation than fat transfer alone, according to the new report. The lead author was ASPS Member Surgeon Roger K. Khouri, MD of Florida International University and Miami Breast Center.
The technique is an adaptation of the increasingly popular autologous (patient's own) fat transplantation technique. In this approach, fat obtained by liposuction from one part of the body is transferred for use in breast augmentation and re-shaping.
In the technique used by Dr. Khouri and colleagues, the patient first undergoes several weeks of "pre-expansion" treatment. This is done using Dr. Khouri's invention, Brava®, a bra-like device that uses gentle negative pressure (a vacuum) to gradually expand the breast. Brava pre-expansion provides extra room in the breast, along with a "fibrovascular scaffold" that the transplanted fat cells can occupy. The patient also wears Brava for a week or so after fat cell injection. The study presents the results of the new technique in 81 women who desired breast augmentation but didn't want implants. All but ten patients used Brava as instructed before the fat transfer procedure.
One year after surgery, breast volume was increased by an average of about 230 cc (about eight fluid ounces) in women undergoing the Brava procedure. That was significantly greater than the 130 cc average reported by previous studies using fat transplantation alone without pre-expansion. The difference was explained by increased survival of transplanted fat cells after pre-expansion - about 80 percent, as measured by MRI scans before and after surgery. This compared to about 55 percent fat cell survival without pre-expansion.
There were no major complications. Sixteen percent of women had areas of fat cell necrosis (cell death), which was harmless and easily detected on mammograms. While the idea of breast fat transfer is not new, it has seen a resurgence in recent years, with several groups of plastic surgery researchers reporting successful results. However, relatively low survival of the transplanted fat cells has been a limiting factor. Without pre-expansion, there is simply not enough room within the breast for the transplanted fat cells to survive and thrive.