BRAVA, the Key to Successful Fat Transfers

Dr. Khouri is the inventor of BRAVA, a soft gel-like bra which is an external breast tissue expander. It is the Brava that makes his Brava + AFT breast augmentation and reconstruction technique possible. For women who want cosmetic breast augmentation or for breast cancer patients who want reconstruction, the options are no longer limited to the traditional methods of implants or flap surgeries. For specifics of BRAVA use for Breast Augmentation through Fat Transfer or Breast Reconstruction please look on those pages of this site.

In order to understand how the BRAVA + AFT (Autologous Fat Transfer) procedure works, we must first begin with an explanation of the BRAVA device. BRAVA consists of plastic domes that fit over the breasts. They are held in place by a mesh-like bra.

The BRAVA Device. BRAVA consists of plastic domes mounted on a gel rim that adheres to the skin around the breast to maintain the vacuum seal (left). It comes with a comfortable garment and is worn like a bra, albeit a large one (right).

How BRAVA Works

BRAVA works by placing a gentle amount of negative pressure on the entire breast. This negative pressure actually stretches the breast with its internal tissue. The skin and all the underlying tissues down to the chest wall expand to create a fertile matrix that will allow large volumes of fat to be transferred and then to survive. This technique, known as tissue expansion, is not new, but our application is.

The BRAVA Effect

Thirty-year-old woman who wanted a natural breast augmentation with her own fat.

(Bottom Center) To ensure survival of the large volume of fat needed for the augmentation, she wore BRAVA for 4 weeks and had an excellent BRAVA effect prior to grafting.

(Top Center) The lines drawn on her breasts indicate the needle stick injection sites and the direction of the multiple cannula passes required to diffusely and evenly fill up the expanded breast tissue.

Essentially all of the transplanted fat survived. After this procedure, we measured by MRI a 280 mL augmentation per breast with no evidence of fat necrosis.

The Regenerative BRAVA Effect

(left) MRI scans of breasts with contrast in a patient before BRAVA use. (Right) After 3 weeks of 10 hours/day of Brava use. Note the enlarged parenchyma and the marked increased vascularity.

The internal effects and benefits of the BRAVA expansion compares to no other method for breast augmentation and reconstruction. The breast regenerates a tremendous amount of blood supply and an abundantly enlarged fibro-vascular scaffold structure . . . the ideal circumstance for fat grafting.

How BRAVA is Used

The BRAVA + AFT process begins with by wearing BRAVA for a few weeks or a few days if the more efficient mechanical pump is used, while you slept, stayed at home, or wear larger, loose-fitting clothes when out. Using the BRAVA created an adequate matrix . . . a scaffold for fat to be injected later in conjunction with an outpatient liposuction procedure.

Portable Intermittent High Pressure BRAVA Pump. Patient is carrying the more efficient BRAVA pump which will allow her to reduce from 4 weeks to 10 days the time required to achieve an adequate BRAVA expansion effect.

The Importance of using BRAVA

Use of BRAVA is somewhat akin to the farmer preparing the field before planting his seeds. He knows that to reap a good crop, a tiny plot will not suffice to sow all the needed seeds. To achieve the desired crop he needs to first find a way to make his plot larger. He also knows the soil must be prepared by plowing it before planting.

Just as the proper-sized field and the plow are essential for a good crop, BRAVA is essential for successful large-volume fat transfer. The surgeon who is not using BRAVA is like the farmer who jams all his seeds onto a tiny piece of hard ground. Some of them might survive and grow, but many, if not most, will perish.

The farmer analogy is one we will frequently refer to throughout this book. To have the greatest success the careful good surgeon, just like the good farmer, has to abide by the following four S’s:

1. The Soil. This is the recipient breast site. It has to be well fertilized and be of adequate size to accept all the seeds needed for the desired crop.
2. The Seeds. This is the fat graft. It has to be gently harvested and carefully handled to preserve its sprouting ability.
3. The Sowing. This is the process of grafting. It has to be done methodically with craftsmanship, one seed at a time. We call this procedure micrografting.
4. The Support. This is the important post-grafting care of the breast that nurtures the seedling to ensure survival of the graft.