Background: Breast augmentation by autologous fat transfer is an appealing alternative in need of scientific validation.
Methods: In a prospective multicenter study, 81 women (age range, 17 to 63 years) wore the Brava device, a bra-like vacuum-based external tissue expander, for 4 weeks and then underwent autologous fat injection using 10 to 14 needle puncture sites into each breast in a three-dimensional fanning pattern (average, 277 ml volume injected per breast). Patients resumed Brava wear within 24 hours for 7 or more days. Pretreatment and posttreatment breast volumes were derived from three-dimensional volumetric reconstruction of magnetic resonance imaging scans, and outcomes were compared with a meta-analysis of six recent published reports on autologous fat transfer breast augmentation without expansion. Follow-up ranged from 12 months to 6 years (average, 3.7 years).
Results: Breast volume was unchanged between 3 and 6 months. Seventy-one of the treated women were compliant with Brava wear and had a mean augmentation volume at 12 months of 233 ml per breast compared with 134 ml per breast in published series without Brava (p < 0.00001). Graft survival was 82 ± 18 percent compared with 55 ± 18 percent without Brava (p < 0.00001). There was a strong linear correlation (R 2 = 0.87) between pregrafting Brava expansion and the resultant breast augmentation. There were no suspicious breast masses or nodules. Magnetic resonance imaging recognized a 16 percent incidence of fat necrosis easily identified at 1-year mammographic evaluation.
Conclusion: The addition of Brava expansion before autologous fat grafting leads to significantly larger breast augmentations, with more fat graft placement, higher graft survival rates, and minimal graft necrosis or complications, demonstrating high safety and efficacy for the procedure.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Key Biscayne and Miami, Fla.; Regensburg, Germany; Milwaukee, Wis.; and Boston, Mass.
From the Division of Plastic Surgery, Florida International University; the Miami Breast Center; Klinik für Plastische und Ästhetische Hand- und Wiederherstellungschirurgie, Caritas-Krankenhaus St. Josef; Orthopaedic Surgery, Medical College of Wisconsin; Surgical Planning Laboratory and Radiology Breast Imaging, Brigham and Women's Hospital, Harvard Medical School; and the Department of Surgery, University of Miami.
Received for publication August 23, 2011; accepted November 29, 2011.
Preliminary study results presented at the Annual Congress of the American Society for Aesthetic Plastic Surgery, in Orlando, Florida, May 21 through 25, 2006; interim results presented at the Annual Congress of the American Society of Plastic Surgeons, in Seattle, Washington, October 23 through 27, 2009.
Disclosure: Dr. Khouri has an equity interest in Brava, LLC, the manufacturer of the Brava device, and is an owner of the company that makes the Lipografter described in the article. The other authors have no financial interests to disclose.
Roger K. Khouri, M.D.; Miami Breast Center, 580 Crandon Boulevard, Key Biscayne, Fla. 33149, firstname.lastname@example.org