The authors describe the techniques that use the principles of fat grafting to allow them to successfully graft megavolumes (250-ml range) of autologous fat into breasts. The Brava external volume expansion device preoperatively increases the volume and vascularity of the recipient site. Low-pressure liposuction and minimal centrifugation are used to gently extract and purify the adipose tissue with minimal trauma. Even and diffuse reinjection of the fat increases graft-to-recipient interface and reduces interstitial fluid pressure. Postoperative Brava use protects the graft and acts as a three-dimensional immobilizing splint. By adhering to these techniques, we have been able to graft megavolumes of fat into the breasts of over 1000 patients and obtain substantial long-term volume retention.
Miami, Fla.; Verona, Italy; Ann Arbor, Mich.; and Houston, Texas
From the Miami Breast Center; the Herbert Wertheim College of Medicine at Florida International University; the University of Verona; and the University of Michigan Medical School; Baylor College of Medicine.
Received for publication April 27, 2013; accepted October 18, 2013.
Disclosure: Dr. Khouri has an equity interest in 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 K-VAC syringe and AT-valve.
Roger K. Khouri, Jr., B.S., 1113 Freesia Court, Ann Arbor, Mich. 48105, firstname.lastname@example.org