The harvesting of fat from another area of the body using a gentle “liposuction” technique, then grafting it to a different location is not a new concept. Fat grafting is commonly used to perform touch-up procedures to both autologous and implant breast reconstructions. Recently, however, this technique has been used to reconstruct the entire breast mound. Our clinic is one of the few centers in the nation that are able to offer fat grafting as another option to women for breast reconstruction.
Traditional tissue expansion places the expander under the tissues, pushes tissues out and thins the tissue in order to create a cavity. The cavity is filled with an implant. Fat grafting, however, doesn’t need an empty cavity. Instead, it requires vascular tissue surrounding droplets of fat to keep it living tissue. The BRAVA system expands the tissue with external suction for 4-5 weeks for 10 hours each day. Then, as an outpatient procedure, fat is suctioned from another site (such as the abdomen, hips, thighs, buttock) and injected into the mastectomy defect. This cycle is repeated 2-4 times on average depending upon the desired volume of breast reconstruction.
Fat grafting breast reconstruction may include the following benefits:
- Use of the woman’s own tissue
- Minimal incision scars (the cannulas for suction and grafting need 2-4 mm incisions)
- Little or no hospital stays
- Short recovery times
- Opportunity to remove fat from unwanted areas
The downsides to fat grafting are that it takes at least two sessions and the patient wears an external suction device for at least 10 hours daily. Because the BRAVA device is under review for this indication (hence the clinical trial), most insurance companies will pay for the operative procedures associated with fat grafting, but not the BRAVA expansion system (even though it is less expensive than the cost of an implant).