There is a lot of media hype around stem cells and a number of other additives touted to improve the results of fat grafting. Unfortunately, these are all marketing hypes with limited science backing. Although in the lab, on rats, stem cells and other additives might enhance the survival of fat grafts, none of the carefully controlled studies in patients have shown that any of these additives provide a significant beneficial effect compared to simple fat grafting. As a matter of fact, the FDA is clamping down on these so-called “Stem Cell Centers”. Doctor Khouri is a recognized international expert and opinion leader on that subject. He is a member of the Stem Cell Task Force, he has published extensively on this subject in peer reviewed scientific medical journals and was recently asked by the American Society of Plastic Surgeons to write an authoritative review on that matter in Plastic and Reconstructive Surgery, the Official Journal of the Society. To reconstruct a breast we need large volumes of fat to survive. The limitation of large volume fat grafting is a recipient large enough to accept this large graft volume. It is a recipient site limitation; the quality of the fat is not much of a rate-limiting factor in the clinical applications. At the Miami Breast Center, we shun away from this hype meant to fool the gullible. We espouse the guidelines of the FDA and graft back unprocessed, and intact the fat we harvest by simple gentle syringe liposuction. Our results speak for themselves.
If you have started using the hand pump more than a couple squeezes when the pump vibrates you should stop that until you decide when you will go in for the surgery. Using BRAVA to obtain some permanent growth requires a different wear protocol than using BRAVA as a precursor for surgery We had guided you to start BRAVA in the non-surgical traditional manner, sport box only and you could use the hand pump just to get a quicker seal. However, you need to know that if you have been doing any cycling repetitions or pumping up with the hand pump to extreme levels, yes, you will see greater swelling but you may also see greater levels of sagging in the end if you don’t do the lipo filling surgery. Dr Khouri always says that the ultimate outcome of the fat transfer process lies in the hands of the patient; what he is referring to is using BRAVA’s correct protocol for the correct procedure and the intense wear and pressure is only for the Surgical route: the fat transfer. Certainly even for the Non-Surgical routine, the more you wear BRAVA, the better result you may achieve but that does NOT include increased pressure. Non Surgical protocol is low pressure over extended periods of time and it all depends on their circumstances as to how much permanent “gain” they may achieve.
Yes, we can help you replace your old implants with your own fat tissue. At the time of implant removal we can graft some liposuctioned fat in the stretched out breast tissue. This will give you some augmentation, but not quite as large as what you had with the implant (about 50%). That is, assuming we remove 400 ml implants, we can give you back about 200 ml of natural augmentation in one small out patient procedure. This step will not require BRAVA. Should you still want to be larger, you will need to wear BRAVA 3-4 weeks post-op and then get a second fat grafting procedure that could, if you desire, make you even larger than your implanted size.
Yes, we have the very best procedure for the treatment of tubular breast deformities. We improve the contour, enlarge and lift the breast without any incision or scar through fat grafting after you have used the BRAVA device for a month or so. Dr. Khouri has the largest experience in the U.S. with fat grafting the breast and has presented large clinical experiences at many national & international plastic surgery meetings. Our results are permanent. What you end up within your breasts is your own fat. It is live tissue that will fluctuate with your body weight. Like any woman with natural breasts, they will enlarge as you gain weight and decrease as you lose it. However, since after the liposuction, a lot of your body fat will reside in your breasts (having removed it from its normal sites), gaining weight will preferentially enlarge your breast which will be the only remaining depot for the fat.
Breast sagging is an effect of gravity and ideally you should wear supportive bras that help reduce the gravitational pull on your breast. That question needs to be answered individually. Whether your breasts sag again also depends on many variables including the size of your breasts, whether you go through childbirth after the surgery, etc. During your consultation you should discuss this with Dr. Khouri.
It is true that Brava is no longer available. But our extensive experience with this procedure has convinced us that we get the best results if we graft a pre-expanded recipient site. Without expansion, a cautious surgeon will only graft the small amount of fat the tissues can tolerate, resulting in minimal volume gain. Should your surgeon be more aggressive and graft more, there will be a lot of temporary swelling; but since most of that fat will not survive, the end result will be very poor. Dr. Khouri, the inventor of Brava, still offers an external vacuum expander (EVE) to his patients. If you already have implants, your tissues are stretched. Removing your implant or replacing it with a smaller one leaves some tissue laxity that is essentially similar to the external vacuum expander effect. Therefore you might not need the external vacuum expander (EVE) if you still have implants. If you need EVE, during your initial consultation, the Doctors at the Miami Breast Center will fit you with the expander, make sure you understand its use and can tolerate the required treatment.
Yes, after chemotherapy you are certainly able to have your breast reconstructed with fat grafting. However, we prefer that you complete your Herceptin treatment before the procedure.
If the transferred fat has restored its blood supply and became viable again in its new environment it will last as long as you do. Like the skin grafts applied on burns or wounds, if the skin graft takes, it stays there forever. Unfortunately, many surgeons pump inside the breast large amounts of fat that fail to ultimately survive. The body will gradually re-absorb over time this dead fat and the final result ends up very poor. At the Miami Breast Center we do our best to avoid over-grafting. We match the graft amount to the recipient capacity and avoid injecting too much graft that fails to survive. What you see at about 3 months after grafting, once the edema of surgery has subsided, is more than 95% permanent. However, since this transferred fat is live and metabolically active tissue, it might increase in size if you gain weight and decrease if you loose the weight.
Cost of the BRAVA System varies depending if the BRAVA needs to be customized in case of different sized breasts. Reduced prices are available if patient schedules for fat transfer surgery. For more details on pricing please call 305-365-5595.
