Fat grafting of the reconstructed breast with external expander unit (Brava^®)

We started performing free flap surgery for breast reconstruction in 2006. However, in certain cases, the volume of the reconstructed breast may be insufficient because of flap atrophy. When this inadequacy is small, we perform fat grafting once or twice: however, when it is large, several procedures may be necessary. The domes of the Brava^® external expander unit were used in 14 patients who received autologous fat injections to improve contour deformities of breasts reconstructed with perforator flaps from March 2012 to June 2014. The Brava^® unit was employed for 4 weeks and was worn for 10 h/day, both before and after the procedure. Reconstruction was performed with a deep inferior epigastric perforator (DIEP) flap (57%), superior gluteal artery perforator (SGAP) flap (14 %), inferior gluteal artery perforator (IGAP) flap (14 %), or posteromedial thigh (PMT) flap (14 %). An average volume of 237 ml of fat was injected into each breast. Patient follow-up duration averaged 13.2 months. There was one complication. One patient was found to have small lumps. The use of the Brava^® unit for autologous fat grafting enabled safe and effective transfer of a large volume of fat to a reconstructed breast. Our experience has shown that the Brava^® external expander unit is useful for autologous fat transfer in breast reconstruction with the free flap procedure.