Breast Reconstruction for Breast Asymmetry Using Recipient Site Pre-Expansion and Autologous Fat Grafting

Abstract

A single case is reported utilizing, recipient site pre-expansion with BRAVA (Brava, Inc, Miami, FL) followed by autologous fat grafting to the breast in a patient with severe breast asymmetry. Recipient site pre-expansion, used 2 to 3 weeks before fat grafting and 2 weeks after fat grafting may have both practical and theoretical benefits in optimizing the volume and enhancing the survival of grafted adipocytes, the mechanism of which is discussed. Recipient site pre-expansion and fat grafting may have early clinical adoption in cases of severe asymmetry, tuberous breasts, and other deformities that are difficult to treat with current reconstructive techniques, but studies are needed to clearly delineate its safety and its role.

Breast reconstruction with fat grafting and BRAVA® pre-expansion: Efficacy evaluation in 45 cases

“…All patients that wish to have breast reconstruction only with fat grafts need to have enough fat deposits to sustain this type of reconstruction. Literature [3,4,15,16] supports the fact that we have in this area a vast experience with a homogenous series produced by the same surgeon using the same technique for several indications.…”

“…The demand for breast reconstruction using only fat grafts has increased for us because the patients want a natural result with the advantage of body contouring by liposuction. The pre-expansion system BRAVA 1 has been used for several years in the United States [3] for receiving site before lipofilling [4]. We wanted to achieve our own experience with the association BRAVAlipofilling in breast reconstruction.…”

Tolérance de la pré-expansion BRAVA en complément des transferts graisseux dans le sein

“…La contention post opératoire par le système BRAVA contribuerait à immobiliser les cellules greffées. Del Vecchio [6] pense également que la préparation du site receveur est un facteur important dans la prise de greffe adipocytaire.…”

Autologous Fat Transplantation – A Paradigm Shift in Breast Reconstruction

“…Despite the large number of patient series of breast reconstruction patients receiving small amounts of fat as a final touch for achieving better aesthetic outcomes, there are few reports of "core volume" breast reconstruction being done exclusively by fat grafting (Del Vecchio, 2009, Babovic 2010, Panettiere et al 2011, Fitoussi et al 2009. Because in all but one of these reports pre-expansion was not used and one begins with an absent breast mound or a thinned mastectomy skin flap, there are recipient site capacity issues in these cases and these operations often require more than 3 sessions.…”

“…A review of the literature reveals there are a growing number of published reports on the use of fat grafting in breast reconstruction after surgery for breast cancer. While some of them are case reports (Del Vecchio 2009, Babovic 2010, Panettiere 2011, Fitoussi 2009), a considerable number describe their experience with 40 or more patients (Spear 2005, Serra-Renom 2010, Rietjens 2011, Losken 2011, Missana 2007, Delay 2008, Panettiere 2009, Kanchwala 2009). …”