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Aesthetic Applications of Brava-Assisted Megavolume Fat Grafting to the Breasts: A 9-Year, 476-Patient, Multicenter Experience

Khouri, Roger K. M.D.; Khouri, Roger K. Jr. B.S.; Rigotti, Gingo M.D.; Marchi, Alessandra M.D.; Cardoso, Eufemiano M.D.; Rotemberg, Silvia C. M.D.; Biggs, Thomas M. M.D.

Plastic and Reconstructive Surgery: April 2014 - Volume 133 - Issue 4 - p 796–807
doi: 10.1097/PRS.0000000000000053
Cosmetic: Original Articles
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Background: Autologous fat grafting to the breasts was banned in 1987 because of unpredictable graft retention and cyst formation that could not be differentiated from cancer. Surgical and radiologic advances induced a lifting of the ban in 2009. Small- to moderate-volume autologous fat grafting to the breast has become common. The authors present their aesthetic applications of megavolume autologous fat grafting to the breast.

Methods: Autologous fat grafting with Brava preexpansion was performed on 294 patients for aesthetic augmentation, 45 patients for congenital deformity correction, 43 patients for iatrogenic deformity correction, and six patients for implant-to-fat conversion. Autologous fat grafting for implant-to-fat conversion was performed on 88 patients without Brava. A case example is presented for each indication. The baseline, perioperative, grafted, and postoperative volumes were recorded.

Results: Follow-up ranges from 6 months to 9 years (mean, 3.5 years). The mean volume grafted was 346 ml per breast, and the mean postoperative augmentation measured at least 6 months postoperatively was 266 ml per breast. No patients required open biopsy or were diagnosed with cancer. There was one pneumothorax, requiring a temporary chest tube, with no further complication.

Conclusion: Large-volume autologous fat grafting after Brava use or implant removal is a safe and effective alternative for breast augmentation and deformity correction.


Video Discussion by Daniel A. Del Vecchio, M.D., M.B.A., is available online for this article.

Miami, Fla.; Ann Arbor, Mich.; Houston, Texas; and Verona, Italy

From the Miami Breast Center; the University of Michigan Medical School; Baylor College of Medicine; and the University of Verona.

Received for publication August 26, 2013; accepted October 23, 2013.

Disclosure: Roger K. Khouri, M.D., has an equity interest in the company, Brava, LLC, the manufacturer of the Brava device. He also has an equity interest in Lipocosm, the manufacturer and distributor of the Lipografter, consisting of the KVAC Syringe and AT-Valve. None of the other authors has any conflicts of interests to disclose.

A Video Discussion by Daniel A. Del Vecchio, M.D., M.B.A., accompanies this article. Go to and click on “Video Discussions” in the “Videos” tab to watch.

Roger K. Khouri, M.D., 580 Crandon Boulevard, Key Biscayne, Fla. 33149,

©2014American Society of Plastic Surgeons