Shaping of the Unaffected Breast with Brava-Assisted Autologous Fat Grafting to Obtain Symmetry after Breast Reconstruction

Abstract

Background: In breast reconstruction, symmetry is a vital issue. However, when the original breast is unusually shaped or the patient desires augmentation at the time of reconstruction, obtaining symmetrical breasts becomes difficult.

Objectives: The authors performed shaping of unaffected breasts by Brava-assisted autologous fat grafting to enhance breast symmetry, and evaluated the clinical results to validate this new approach.

Methods: Brava-assisted autologous fat grafting was performed to the unaffected breasts of 12 patients who had undergone unilateral breast reconstruction. The procedure was used for augmentation in six patients and to correct ptosis, volume, and tuberous breast deformity in three, two, and one patient, respectively. Clinical outcomes were assessed in all 12 patients.

Results: All patients could complete fat grafting within two sessions (one session in nine patients and two sessions in three patients). The mean volume of grafted fat per session was 211 cc in all patients. The mean retention rate of grafted fat was 58.9% in the 10 patients for whom the retention rate could be calculated using preoperative and postoperative magnetic resonance imaging (MRI). Postoperative MRI revealed small benign foci in two patients (16.7%), which were not palpable and did not become a clinical problem. A postoperative mammography revealed a small agglutinate calcification in one patient, which was determined to be benign through biopsy.

Conclusions: Shaping the unaffected breast by autologous fat grafting combined with Brava is predictable, effective, and feasible as an aesthetic adjunct to unilateral breast reconstruction to achieve breast symmetry.

Level of evidence: 4 Therapeutic.

Figure 1.

A 47-year-old woman underwent left mastectomy and simultaneous insertion of a tissue expander. (A) Her original breast was very small, and no existing implants were of adequate size. After insertion of a 155 cc implant (CPG321, Mentor, Santa barbara, California) on the left side, she underwent Brava-assisted fat grafting twice to the right side (180 and 100 cc). During preoperative Brava use, the right breast enlarged, and the nipple color became more pigmented (B). Mammography of the right breast before (C) and after 3 weeks of 10 hour/day preoperative Brava use (D) shows increased intensity. (E) 51 months after two fat grafting sessions (180 and 100 cc).

Figure 2.

A 40-year-old woman underwent right mastectomy and simultaneous insertion of a tissue expander. She underwent a free deep inferior epigastric perforator flap procedure at a later date. (A and B) Her unaffected left breast was atrophic due to postpartum deflation. Two sessions of Brava-assisted large-volume fat grafting (260 and 300 cc) were performed. (C and D) 57 months after the last fat grafting session. The effect of the inframammary creation of the left breast, which was performed later, was slightly insufficient and the volume, especially in the lower pole, may still look deficient. However, the volume was actually sufficient. (E) Postoperative MRI indicated that grafted fat was present in all layers: the subcutaneous, subglandular, and intra- and submuscular regions.

Figure 3.

Oxygen partial pressure (PaO₂) in subcutaneous fat of a normal breast. By applying external negative pressure via Brava (∗), PaO₂ gradually increased and then decreased rapidly after releasing the negative pressure (#; data from a real-time oxygen partial pressure monitor; Nihon Bioresearch, Inc., Tokyo, Japan).