Would I still need to wear a Brava prior to a fat transfer if my skin is already stretched from breast feeding then volume loss?

Question

I am considering a fat transfer for breast augmentation. My breasts are barely a B after three years of breastfeeding. I was routinely a full B prior to breastfeeding and my breasts increased to over a D cup while nursing. My question is, if my skin has already been stretched because there was previously more breast tissue/breast volume, and that volume is now gone, would I still need to wear a Brava? I am trying to understand what exactly the Brava does, and if it is required in all cases.

Michele A. Shermak, MD · Answer

The short answer is "no." Brava is not widely available as it is not widely endorsed. The developers of the technology are its primary advocates. Fat transfer take depends on how much tissue is currently present, as the more tissue present, the more fat that can be hosted and the less absorption. A second go at fat transfer typically results in better take than the primary procedure.Be sure to see a board certified plastic surgeon. You can find one at plasticsurgery.org.I love fat transfer to the breasts - it's a great technique when done well! Best of luck to you!

Rodney A. Green, MD · Answer

If you have skin laxity and you have sufficient basic breast volume as well as donor fat available you may not need any preparation. Sometimes you may need a second session of fat injection to accomplish your goal but even that may be preferable to wearing the Brava device for a month before surgery.

Kenneth Hughes, MD · Answer

Hello, thank you for your question. A Brava device is a large external suction device, similar to a breast pump, that a patient wears over the breast to expand the breast tissue.  Breast fat transfer is a great tool to balance breasts, improve symmetry, and gain up to one cup size in volume. The fat transfer volumes to each breast may range from 240 cc to 360 cc in most cases. About 50% of the fat survives, on average.  Some patients will require more than one session of fat grafting to achieve the best results. Schedule an email, Skype or in-person consultation with a board certified plastic surgeon.

Gary M. Horndeski, MD · Answer

Since your breasts have increased in size while breast feeding and decreased after, you have excess skin.  The excess skin allows you to have a breast lift.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  The Brava system is no longer available in the US and not necessary in your case.Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear  lex_ladybug,
every plastic surgeon has his own postoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Sarah Mess, MD · Answer

I have performed fat transfer to breast in private practice since 2005. I have used the Brava system in the past, but I found it to be an unnecessary burden with questionable benefits for patients. There are many variables in fat transfer, and a tight envelope can restrict initial fat transfer volumes just as it can limit the size of an implant in implant augmentations. (Which does not appear to be your case given your description) Even in these cases I do not believe Brava is beneficial. There are numerous examples on my website and Instagram accounts of what can be achieved with fat transfer to breast without Brava expansion. If your doctor is a Brava advocate, ask him/her why they recommend it and get a good understanding of what it will entail.

Wendell Perry, MD · Answer

I have never used a brava prior to fat transfer to the  breast.  what I have found is that the looser the skin envelope the  has a higher percentage of fat graft survival.  In gastric bypass patients I even say 90 to 100% of the fat takes.  Try to look at a lot of before-and-after pictures of the fat transferred to the breast.  Look for someone who before the surgery has a skin envelope and breast ptosis similar to yours and then see what the results look like.  This way you can get an idea of what's possible with fat transfer.  Fat transfer does not look like a breast augmentation with an implant.

Kamran Khoobehi, MD · Answer

The pre-expansion of the breast tissue before fat grafting does make sense in patients who never benn pregnant or have very tight breast. I been doing fat grafting without expansion with great sucess since 2006. Please see the link

Connie Hiers, MD, FACS · Answer

I do not use the Brava since the fat is not placed under the skin, but into the actual breast tissue. The Brava expands the skin much more than the actual breast. Also, it is painful and somewhat cumbersome to wear, and many women choose not to wear it. Most surgeons who do fat transfers do not use the Brava prior to the transfer. Do remember that a fat transfer is limited in the amount of fat than can be transferred in one session.

David Janssen, MD, FACS · Answer

The use of the external suction device is less to expand the skin than the extracellular matrix.  This is the area between the cells where the fat is being placed.  Dr. Roger Khouri who developed it still uses it but it is not commercially available in the United States.  I do think it helps with improving the percentage of fat that makes it after fat transfer but it is not a deal breaker to use.  I have not used it in my practice and do fat transfer several times every week.

Would I still need to wear a Brava prior to a fat transfer if my skin is already stretched from breast feeding then volume loss?

Answers (10)

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