BACKGROUND: With a new ASPS position paper in 2009, the possibility of fat grafting to the breasts has gained increased popularity. For such a procedure to have a role in plastic surgery, it must be performed in a reasonable period of time, yield predictable, reproducible results, and be safe. Recent published reports, book chapters and presentations at meetings suggest the use of preoperative external expansion to the breast may be an important variable in improving fat graft survival. The purpose of this study is to validate the role of external pre-expansion using the BRAVA System and to help standardize the technique.
METHODS: Over a 2 year period, 25 patients ranging from 21 years of age to 38 years of age were selected for this procedure. Patients ranged from breast augmentation to Poland Syndrome deformities. Following initial baseline MRI, patients were treated with 3 weeks of external preoperative breast expansion 10-12 hours a day using the BRAVA bra. Following this, they underwent mega volume fat grafting to the breast, ranging from 220 cc to 540 cc. High speed centrifugation was not used in this series. Rather, the technique of “serial decanting” for separation of fat from crystalloid allowed for more efficient processing, and the average operating time was 2.5 - 3 hours to perform these procedures. Patients were followed up with serial photography and MRIs were obtained at six months post grafting.
RESULTS: All patients treated had visible volume increase at six months. Percent volume increases were quantified aided by MRI, and ranged from 1.3x to 3x original volume. The variable that correlated best with final volume increase was preoperative expansion size. Details of patient selection, a prognostic classification of patient anatomy, instrumentation, intra-operative technique and postoperative management are outlined.
CONCLUSIONS: External pre-expansion is an important variable in mega-volume fat grafting to the breasts. It allows for more efficient surgery and may obviate the need for time-consuming high speed centrifugation. Patient selection and preoperative preparation are as important as the surgical technique in regards to the success of the result. When following such a standardized process, breast augmentation and reconstruction using BRAVA pre-expansion appears to yield safe, reproducible results.