Pre-and post-operative brava'-assisted fat grafting for breast reconstruction

Large volume fat grafting into a tight space causes increased interstitial fluid pressure and the coalescence of crowded graft droplets. As a result, graft survival decreases, and complications from fat necrosis, such as the formation of oil cysts and large calcifications, arise. Brava®, an external breast expansion device, perioperatively increases the volume and vascularity of the recipient site, reduces interstitial fluid pressure at the time of fat grafting, and facilitates large volume fat transfer. In this series, we describe our method of Brava-assisted autologous fat grafting for breast reconstruction. The advantages of this method are as follows: reduced surgical invasiveness, decreased surgery length as an outpatient procedure, and the reconstruction of a natural-feeling breast. The most common complication is contact dermatitis from wearing the Brava device. This method is not suitable for patients with thin subcutaneous tissue and a large skin defect following mastectomy, although it is very effective for patients with an abundant skin flap after nipple-sparing mastectomy.