Fat transfer provides alternative to breast implants

After Brava® pre-expansion, patients' own fat can be used to increase breast size

April 30, 2012
American Society of Plastic Surgeons (ASPS)

Preoperative 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, M.D., of Florida International University and Miami Breast Center, Key Biscayne, Fla.

Pre-expansion provides better results with injected fat

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 - for example, the thighs - is transferred for use in breast augmentation and reshaping.

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 10 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 8 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.

A less-invasive alternative for breast augmentation?

The difference was explained by increased survival of transplanted fat cells after pre-expansion - about 80%, as measured by MRI scans before and after surgery. This compared to about 55% fat cell survival without pre-expansion.

There were no major complications. 16% 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.

Using Brava before and after fat transplantation provides more optimal conditions for successful fat transfer, Dr. Khouri and colleagues believe. Another group of plastic surgeons recently reported similarly good results with Brava pre-expansion (Plastic and Reconstructive Surgery, June, 2011).

With recommended use of the Brava device before fat transfer, at least some women can expect to double their original breast size in a single, outpatient procedure with no incision, Dr. Khouri and coauthors write. While further research and experience are needed, the researchers think their study "establishes a benchmark and a platform for further potential improvements."