Journal time. For those reading about fat grafting for breast augmentation (where you do liposuction and use that fat to create a larger breast instead of using an implant), you may know Dr. Del Vecchio has become a well known name in the field. I am a huge fan of Dr. Khouri as well. It is nice to see someone else’s information and understanding of the subject.
What is this article? “Breast Augmentation Using Preexpansion and Autologous Fat Transplantation: A Clinical Radiographic Study.” Published in Spring 2012 in the Plastic and Reconstructive Surgery Journal.
Who? Prospective exam of 25 patients who were treated with the BRAVA system for 3-4 weeks ahead of grafting, surgery, BRAVA after for 2-4 weeks, and then reevaluated 6 months after. MRI volumetric analysis was done to document change in size.
Details and pearls?
- You MUST overexpand. “Must expand to 3 to end up at 2”
- Patient compliance with BRAVA very important
- Tissue compliance is important as well. Patients who have not had kids, have dense breasts, or constricted breasts were more difficult.
- Procedure time took a little over 2 hours
- He transfers fat in staged sessions frequently for those with constricted, tuberous breasts, dense breasts, or young women who have not had children yet.
- “preexpansion classification based on breast morphology
- TYPE I- multiparous (many kids), soft breast—– needs one grafting session
- TYPE II- nulliparous (no kids), dense breast —– needs 1-2 grafting sessions
- TYPE III- constricted or tuberous breast ——– needs 2-3 grafting sessions
- “preexpansion classification based on breast morphology
- His overall amounts transferred are cumulative, so he often is able to graft more volume total. His overall fat survival rates ranges from 47-86%. Most are in the 50-70% range.
Thoughts? As many of you know, I am a fan of fat grafting. I think it is a viable technique. I think the two limiting factors are
- 1. You must have the space to graft into. When I see the skin become taut, I cannot put more fat in. “Expand to 3 to end up at 2.”
- 2. You need fat. One issue I see in my athletic Northern California patients is they are thin. Simply, I need to harvest enough fat to have fat to graft. If you are super thin with no fat pockets, it makes it difficult to have enough fat to work with. Your final breast volume result is related to the amount I have to use for fat transfer.
- For cosmetic patients, you need to consider the potential issues from the liposuction. As my patients are cosmetic patients, you also need to consider the change in skin tone, contour, etc from the area where the fat was taken. I have had over a decade of liposuction experience, and I will discuss your fat distribution and skin tone with you when I see you. How aggressive do you want to be for the fat removal?
Great article.