Fat Transfer, also known as fat grafting, is commonly used to perform touch-up procedures to both autologous and implant breast reconstructions. The removal of fat from one area of the body, using a gentle “liposuction” technique, then grafting it to a different location of the body is not a new concept. Recently, however, this technique has been used to reconstruct the entire breast mound. Using a patient's own tissue is a major advantage as there is no risk of the fat graft being rejected by the body.

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 four to five 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 two to four 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).