Is the Brava Required Before Fat Transfer to the Breasts?
I've read that the Brava system does not work for breast enlargement, but have seen a few recommend it as a precursor to fat transfer. Do all surgeons require this? Why wouldn't I just do the Brava on it's own?
Doctor Answers 7
BRAVA before fat transfer to the breast.
If a patient has really, really tight breasts, Brava is necessary. It loosens up the breast tissue so the breast can accomodate more fat without becoming too tight. It also makes the breast more vascular which is beneficial for fat survival.
I do not recommend Brava lightly. It takes a very motivated woman to tolerate this gigantic breast pump 10 - 12 hours a day. I remember the first time I saw this contraption. I burst out laughing and told the sales rep: NOBODY IS GOING TO WEAR THAT. I was wrong; there are some highly motivated women out there.
Fortunately for me, most of my fat transfer patients have been breast atrophy patients either from child birth and breast feeding or weight loss. They were plenty loose without Brava.
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BRAVA prior to fat transfer for breast augmentation
The science (what happens long term when you inject fat into the breast, does it do nothing bad? cause cancer? cause fat cysts?) is not all sorted out on this procedure. I'm sure we all hope it turns out to be a great way to augment (or even reconstruct) breasts without implants. So the answer is, the current teaching is that BRAVA helps create space and the vasculature to support fat injections, but it not imperative that BRAVA be used. Be aware that this may be a several surgery process. Best of luck to you.
More studies are in the works.
I believe the FDA has found the science behind this to be somewhat anecdotal. To this end several centers have been designated to get the unbiased data necessary to determine efficacy.
As with any new technology we need to carefully evaluate this before it replaces accepted and relatively proven procedures.
The options need to be discussed with your surgeon and you both need to be comfortable with the surgical plan.
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Is the BRAVA external expander required for breast augmentation with fat?
The answewr is yes and no. If you have small breasts with tight skin envelope and tight parenchymal tissues it does help prepare the breast for better fat take. It's been shown on MRI studies that it not only loosens and increases breast volume, but it also helps improve blood supply to the breast. This way the fat has a better survival rate. Most surgeons do not use the BRAVA. In Europe it is rarely used if ever and fat grafting is done successfully without it. Now, it is important to note, that without the BRAVA pre-expansion of the breast, you might need two or more sessions of fat grafting. The reason is, that about 65% of the fat survives in the long run.
Fat transfer to the breast
Fat grafting for breast augmentation does not require the Brava machine. However, it is useful if your native breast skin envelope is tight and it is difficult to transfer large amounts of fat into your breasts. The Brava machine stretches out your breast skin and parenchymal tissue so there is more potential space for grafting fat. For women who have droopy/sagging breasts, this will not be necessary since there is already a lax skin envelope that can accommodate the grafted fatty tissue. As for using the Brava on its own, the result are temporary. Your breasts may get bigger because it stitches out and swells. This does not last and usually tends to revert back to pre-treatment size and shape.
BRAVA and fat transfer
The BRAVA system has been used in some patients for breast augmentation with fat. There is not a lot of research on this subject, but it may enhance the ability to place more fat and may promote better "take". It still does not provide the volume that a breast implant could.
The use of the Brava system plus fat injections for breast augmentation is a new approach done by a few surgeons. I have been somewhat unimpressed with the results and we don't know how the result will hold up in the long term. I would not volunteer for this procedure until the bugs are all knocked out, and that seems a far way off. I guess I'm just a common sense kind of guy.
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