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Brava-assisted fat grafting an incisionless, economic alternative for breast reconstruction

As reported in a recently published study, researchers found the use of the Brava vacuum-based external breast expander plus autologous fat transfer to be a minimally invasive, incisionless, safe, economic and effective alternative to current breast reconstruction options.

The researchers enrolled 488 women between 2006 and 2013 to undergo tissue-engineered breast reconstruction with Brava-assisted autologous fat transfer. Patient age ranged from 28 to 74 years, and patients had a mean BMI of 23.5.

The researchers conducted three different subsets of the procedure: delayed reconstruction, immediate reconstruction and reconstruction of the irradiated partial mastectomy defect. Overall, 1,877 autologous fat transfers were performed on 616 breasts. In the 427 patients who completed reconstruction, the researchers performed 1,790 operations on 568 breasts. Follow-up occurred at an average range of 6 months to 7 years.

The mean number of operations per breast necessary to complete the reconstruction and generate a breast mound was 2.7 for delayed nonirradiated mastectomy and 4.8 for delayed irradiated mastectomy. Immediate reconstruction required 2.1 grafting sessions when nonirradiated, and 4.2 when the breast was previously irradiated, according to the researchers.

Overall, the researchers grafted a mean volume of 225 mL/breast per operation. The mean breast mound volume at 6 months after the last operation was 375 mL/breast.

Immediate reconstruction patients needed fewer procedures and demonstrated better results than delayed reconstruction patients, according to the researchers.

The researchers found completing a satisfactory breast reconstruction with traditional techniques usually required a total of five or six surgeries. Averaging for a three-stage reconstruction with expanders/implants, costs were approximately $33,657, and four-stage reconstruction with Brava plus autologous fat transfer cost approximately $22,458 — thus costing approximately 47% and 66% less than current reconstruction alternatives, according to the researchers.

Among the complications reported were five pneumothoraces and 20 ulcerative infections. The researchers also reported radiographically recognized benign palpable masses in 12% of the nonirradiated breasts and 37% of the irradiated breasts. – by Abigail Sutton

Disclosures: Khouri has an equity interest in the company, Brava, the manufacturer of the Brava device. He is also an equity interest in Lipocosm, the manufacturer and distributor of LipoGrafter, consisting of the K-VAC Syringe and AT-Valve. The other authors report no relevant financial disclosures.