Breast Reconstruction: Bravia Procedure-looks way easier and less painful

[Paula O]

Hi guys,

I am copying and pasting part of what I posted yesterday in the SABCS thread here so it can be found more easily by those wanting to consider and discuss this reconstructive procedure. Has anyone here done their reconstruction using the Bravia procedure? For those of you who have had reconstruction a different way, how does this method look/sound/ compare to what you've done? From somebody who hasn't had reconstruction, it sure looks like a piece of cake compared to what I hear others describe of the other typical methods. I would appreciate hearing any input/opinions anyone cares to share after checking the site and photos in the links below.
Paula

---------------------
Copied from http://her2support.org/vbulletin/showthread.php?t=56835

During dinner at the symposium I had a very interesting conversation with a friendly, young breast surgeon from Brazil that was sitting to my right. A scientist from Germany sat to my left but I don't think he spoke a lot of english. An advocate told me about the "Brava" reconstruction procedure with fat transfer and so I asked this breast surgeon about it. He likes the results of that method and personally knows the doc who developed it in Miami: http://www.miamibreastcenter.com/rec...stectomy-miami --it says no incisions, implants, or new scars and apparently most sensation is maintained--a transfer of your own fat via injection after your skin is loosened up. Anybody here do it this way or have input about it from the website? Here are some of the before and after photos:
http://www.miamibreastcenter.com/rec...e-after-photos
It says no scars but the photos do look like there's a scar on their abdomens (from the liposuction I guess). Where did the mastectomy scar go in the first photo I wonder? It looks gone but I don't know how that can be. I have not had reconstruction. This method is of interest to me possibly. No more surgery and not having the pain that typically goes along with reconstruction sounds good to me.

From the site:

• No Foreign Objects
• No Cuts or Incisions
• No Scars
• Liposuction
  (body sculpting)
• Quick Recovery
• Natural Breasts
• Near Normal Sensation (reconstruction)

Paula

[JennyB]

Paula would be very interested in anything you find out - I have not yet had reconstruction - to be honest I am a little scared of how invasive it will be after radiation. This sounds like a perfect answer?

Hope to find out more...

Jenny

['lizbeth]

I have been watching the use of liposculpture for reconstruction. I know Suzanne Sommers had this done.

I can't wait until these type of breast reconstruction become mainstream.

[Paula O]

When doing a search on the internet yesterday I found a Dr local to me who does the BRAVA procedure and was trained by the Dr who developed it. He gives a free initial consult and his wife is a breast cancer survivor who is supposed to call me today with some info. I think I will probably go in and meet the doc in the next few months and consider it. I was pretty sure I was not going to ever do reconstruction but this procedure seems like a better match for me. However, I know that sometimes things look better than they really are.

I'd want to get rid of my excess weight before proceeding anyway and am not in any rush to do reconstruction ...something for me to think about anyway.

More info for anybody else who wants it:

http://www.breastreconstructionandau...tion.com/brava
What is BRAVA®

The BRAVA® device consists of two plastic domes with a silicone edge seal that fit over the breasts. They are held in place by a custom made bra. Attached to the domes is a small electric suction pump that applies continuous suction to the breast skin and underlying tissues. This suction actually stretches and expands the breast skin and underlying tissues, analagous to expanding a sponge.
This process also increases the blood supply and flow to the tissues and allows much greater volume of fat to be grafted successfully and maintained. A similar concept is used successfully to apply suction to healing wounds to rapidly increase the rate of healing.
It is recommended that the BRAVA® be worn 8-10 hours a day for about 3 weeks before and 3 weeks after a fat grafting procedure. Most women apply the BRAVA® when they get home in the evening and sleep with the device.
The inconvenience of wearing BRAVA® is far outweighed by the improved fat grafting results obtained. For breast reconstruction the benefits are a completely natural reconstruction without any additional large incisions or scars, and far fewer complications than those associated with other reconstruction procedures.
Why BRAVA®?

For the breast augmentation patient, BRAVA® is strongly recommended to allow the maximum amount of fat grafting in a single procedure.
For the breast reconstruction patient, BRAVA® is essential in the breast regeneration process to prepare the tissues for optimal fat grafting.
Preparing breast tissue with the BRAVA® device promotes satisfactory and long-lasting results from breast reconstruction and augmentation. Without the use of BRAVA®, most studies show that the most a breast can be enlarged with a single grafting procedure is about 150cc.
In the US, the average breast implant size is at least 300cc. Trying to introduce too much fat at one time is counterproductive as the fat is under too much pressure and will not survive. By using BRAVA® before the fat grafting procedure,the tissues are stretched to accommodate more fat, and it has been shown that maximum final increase in size is up to 300cc or more.
The Bougainvillea Clinique is one of a select group of plastic surgery practices that participate in a nationwide study protocol using BRAVA® and fat grafting for breast augmentation and reconstruction.
Tissue Expansion for Breast Surgery

BRAVA® is an external tissue expansion device that expands breast tissue in preparation for fat grafting. Tissue expansion is especially important for breast reconstruction cases, in which a significant amount of tissue is removed in mastectomy. Before the BRAVA®, the only way to expand the tissue for breast reconstruction was with an adjustable saline breast implant – the volume of the implant is increased in stages, expanding tissue over time. BRAVA® provides an external means of tissue expansion, without the use of a breast implant. External expansion with BRAVA® is very different to internal expanders used in other reconstruction techniques. Whereas with BRAVA® the tissues are expanded like a sponge to allow more fat to be grafted and survive, internal expanders creat a space under the skin to accommodate a breast implant and actually stretch and thin the skin in the process. Internal expanders are associated with a high rate of complications, particularly in radiated patients. BRAVA® on the other hand has been shown to actually improve the quality of the underlying tissues.
Combining BRAVA® with fat grafting is a true tissue regenerative process. Breasts reconstructed with this procedure is the closest we have yet come to truly regenerating a breast in the mastectomy patient.
Advantages of BRAVA®

The survival of fat is a primary concern in a fat grafting procedure. Some percentage of fat always dies, but tissue expansion promotes the survival of greater percentages of fat.
When fat is grafted to your breast, survivability of the fat is affected by a decreased blood supply, which is brought about by blood vessels that are constricted by the pressure of the newly injected fat. By expanding the tissue before the fat is injected, circulation to the tissue is increased, creating an environment in which the fat can better survive.
Tissue expansion also makes room to accommodate the fat graft, providing the possibility of a larger augmentation.
How big can you go with BRAVA® and Fat Grafting

Generally the amount of fat that can be injected at any one time is dependent on the amount of expansion achieved with BRAVA®, and we use the two-thirds rule. The rule states that your final breast size will be about two-thirds of the size you achieve with BRAVA® expansion. This means that if you want to double your breast size, you have to triple the breast size with BRAVA® before the grafting. The success of the grafting procedure and the amount of fat retained is directly proportional to your commitment to wearing the BRAVA®. The more you expand the breasts before the grafting procedure, the larger the final result will be.
The more committed the patient is to using the BRAVA®, the better the results with fat grafting.

It is important to note that the BRAVA® device is presently FDA approved only for breast enlargement, and is used off-label for combined expansion and fat grafting. Dr. Hartog is a participant in an IRB approved multicenter study with Dr. Roger Khouri, the inventor of the BRAVA® device, combining fat grafting with BRAVA® expansion. A recent published study has demonstrated the safety and efficacy of the BRAVA® expansion with fat grafting process, as well as a significantly higher final fat graft volume and survival.

http://www.healthline.com/hlvideo-5m...ment-517326632
http://journals.lww.com/plasreconsur...&type=abstract
This is the part before the liposuction and injection of fat into chest (some women who have not had mastectomies stop after this point and don't do the liposuction and fat transfer)

http://www.prweb.com/releases/breast...web4605124.htm

Breast Reconstruction Groundbreaking Procedure Gives Cancer Patients Hope

A revolutionary, minimally-invasive breast reconstruction alternative using an external expander called Brava, followed with grafting the expanded mastectomy area with liposuctioned fat . The procedure allows women to recover their natural breasts without another surgery and with the enormous benefit of near-normal sensation in their new breasts and nipples.

Breast Reconstruction with External Expander and Fat Grafting

It allows women to recover their natural breasts without another surgery and with the enormous benefit of near-normal sensation in their new breasts and nipples

Miami, FL (PRWEB) October 6, 2010
The last thing a woman who had a mastectomy or lumpectomy wants, is another major surgery. Dr. Roger K. Khouri MD, FACS has developed a way to give breast cancer patients who have lost their breast(s) or part of their breast to cancer, their breasts back. The technique is a revolutionary, minimally-invasive reconstructive alternative using an external expander called Brava, a comfortable soft gel-like bra, followed with grafting the expanded mastectomy area with liposuctioned fat . The procedure allows women to recover their natural breasts without another surgery and with the enormous benefit of near-normal sensation in their new breasts and nipples.
Although nearly 200,000 women in the US are projected to get breast cancer and suffer a partial or total mastectomy this year, Dr. Khouri’s groundbreaking development in reconstruction offers women an alternate path to recovering back their lost breast which is less painful, less stressful and much more natural.
Dr. Khouri invented Brava almost 10 years ago. However, Brava was solely used for cosmetic breast enlargement purposes in the past. Since then 70,000 women have benefited from his invention. Now Dr. Khouri is revolutionizing breast reconstruction for cancer patients using Brava. “I was performing a breast augmentation on a small-chested patient and it occurred to me that if I could build larger breasts for her, I could build an entire breast for a breast cancer patient”, states Dr. Khouri. “It has become my passion and I see how it is changing women’s lives.” Dr. Khouri also uses this same new procedure for cosmetic breast augmentation with fat transfer.
This new micro-fat grafting procedure begins with the patient wearing the Brava bra, to prepare the recipient breast. The patient wears the Brava, while sleeping, for 3 to 5 weeks prior to the first grafting session.
Not only does Brava expand the skin from the outside, it also has the effect of regenerating an edema-like breast mound through the stretch expansion of tissues and nerves.
Brava also increases the blood flow to the mastectomy scar and improves the radiation effect. This does two important things, which are unique to this technique:
1. It creates an adequate vascular matrix into which the liposuctioned fat is later injected.
2. It allows the patient to keep almost normal sensation in her breasts and nipples.
The procedure is done as outpatient, often under local anesthesia and sedation, and has minimal recovery time. Unlike traditional methods, it involves no incisions, no new scars or foreign objects, yet it recreates an entire, natural feeling breast.
Although liposuction and fat transfers have for years been used to tweak or fine-tune implant or tram flap surgery, this innovative procedure is the very first that facilitates reconstruction of an ENTIRE breast from fat with no major surgery. No longer are the alternatives now limited to the traditional surgery-intensive implant or flap methods which inflict major trauma and scars.
Dr. Khouri conducts fat graft courses where he trains plastic surgeons from around the world on his innovative breast techniques. His upcoming course will take place in Miami on October 30, 2010.
Dr. Khouri has the world's best documented experience on the subject. Dr. Khouri's work was just awarded the best scientific achievement at the Annual Meeting of the European Association of Plastic Surgeons (EURAPS) and he will be delivering his presentation and receiving the award at the 2011 Annual Meeting of the American Association of Plastic Surgeons.
Patients are available for Interviews / B Roll is available
http://www.MiamiBreastCenter.com

----------------

[Ellie F]

Thanks Paula for posting this really interesting procedure. The fact that it avoids a further back or tummy scar is really encouraging. I assume they take excess fat from the abdomen, thighs or hips to transfer?
Please let us know if you get anymore info, it's really exciting and the pictures look so good
Ellie

[vballmom]

There is a thread on BCO discussing this journey: http://community.breastcancer.org/fo...4#post_3330835. My understanding is that it is a long process that requires a lot of commitment.
"Follow my Brava and Fat Grafting Day by Day"

[roz123]

hi ladies
i asked my PS (here in canada) about this. He is head of plastics division for 3 teaching hospitals. He said he knows of this procedure very well (and the miami doc who invented it) and said yes it is too good to be true. He explained that the long term results are not good because they are just transfering fat which can be re-absorbed into the system. With traditional flap procedures they are taking fat and blood supply to keep the tissue alive. It is a very lengthy process with little proven track record. It may be the wave of the future but right now (from his explanation) there are no long term results data. Now keep in mind that this is coming from a doctor who practices in canada which is VERY CONSERVATIVE in using new techniques because of public healthcare. Until a procedure is deemed to be BETTER than an exisiting procedure, the government will not pay for it (and this can take years) In the U.S. many PS offer different services to attract customers. For example, alloderm is still only used in clinical trial in canada whereas it is used frequently in the US for breast reconstruction

[Paula O]

Thanks Roz123 and VBallMom for the very helpful input--much appreciated. I tend to like the tried and true with longer term results the best and am iffy about the whole thing anyway so I dunno. I imagine any reconstruction would also up my risk for lymphedema as they are doing invasive work in that chest quadrant. I'm very proactive and protective trying to avoid lympedema. Anybody here get lymphedema with their reconstructive surgery?

Yes, Ellie, liposuction is used and the fat is transferred from other areas and injected into the chest area. I spoke with the Plastic Surgeon's wife today. She said their facility has the only FDA approved storage banking system for your own fat so you aren't getting liposuction with "fresh fat" each time but some that you banked. Not sure if that's a good thing or not--she seems to think it is because of not so much repeated poking. I wonder how well fat stores without losing viability and why they are the only one with it. She has been a "guinea pig" getting multiple MRIs to assess results carefully. She said approx 80% of the fat they transfer is maintained and not reabsorbed. How does that compare to other method? I told her I would want to lose excess weight first so I don't have shrinkage later and she didn't think that was a good idea--more is better for the procedure she said but I have way more than enough I'm sure and I am not large chested.

The BRAVA machine itself($875 for two sides ) is not yet FDA approved and not covered by insurance. They also would be out of network for me.

I might possibly get a consult just to check it out but sure wouldn't want my breast to shrivel up like a raisin over time! Perhaps I'll leave well enough alone, I'm ambivilent really. My prosthesis is a great match under clothes and my husband is very loving and accepting as is. I had pretty much written off reconstruction until I talked with that breast surgeon from Brazil at dinner at the SABCS and he was extremely positive about it with nothing to gain from me.

Folks who had reconstruction--was it worth all you went through? Happy with your results? I've heard people here say that theirs felt like an elephant on their chest and I've met a couple ladies who had terrible poblems with infection and rejection--whew! It sounds like everybody has significant pain and recovery--is that so?

Paula

[Mtngrl]

This is all very interesting. Thanks for posting, Paula, and for the feedback it elicited.

['lizbeth]

Brava Clinical Trial link:

http://clinicaltrials.gov/show/NCT00466765

[Paula O]

Wow, thanks for the link. I just wrote them for info on the clinical trial and I'll post what I hear.

Paula

['lizbeth]

Hollywood Presbyterian Medical Center is seeking
women for a clinical trial designed to determine
the optimal approach for breast augmentation
surgery using the body's all-natural fatty tissues.
This procedure aims to avoid the
complications associated with silicone
and saline breast implants.


For more information, contact
Hollywood Presbyterian Medical Center
at 323-913-4360.

Additional information about the procedure:
Breast Augmentation using Stem Cell
enriched Adipose fat
What is breast augmentation using stem cell enriched Adipose fat?
This process uses you own fat and your own stem cells to enlarge
your breasts.
How is the procedure performed?
First the doctor uses liposuction to extract fat from your abdomen, thighs or buttocks. The fat is then separated, and half the fat is put in centrifuge and the stem cells are separated from the fat. The stem cells are then mixed with the remaining fat and the enriched fat is injected into your breast.
Why use the stem cells and not just plain fat?
In this study you may chose to have plain fat augmentation instead of stem cell enriched fat for your augmentation. In fact, the purpose of the study is to compare the results of plain fat augmentation versus stem cell enriched fat augmentation.
What is the benefit of using the stem cell enriched fat?
It is believed that by using stem cell enriched fat, the fat will remain viable and not dissipate over time.
Has this procedure been done before?
Yes. In addition to several US centers, a prominent physician with the University of Tokyo has been doing this procedure for over 5 years. His name is Kotaro Yoshimura and he had performed over 500 procedures with excellent results. The protocol we use in this study is the same used by Dr. Yoshimura.
What are the risks?
There are always risks with any surgical procedure. If you elect to enter the clinical study, you will review all the possible risks in detail with the physician so you can make an informed choice about your participation. However, we do not fully understand the risks associated stem cell assisted breast augmentation at this time.
How long does the procedure take?
The surgery takes about two hours. It is done on an outpatient basis and you should be able to go home the same day as the procedure.
What else is involved?
When you enter a clinical study you will have to agree to follow the study protocol. Among other things, you will be required to have at least four follow-up visits at the clinic for 1 year after your surgery. The physician will explain in detail what you need to agree to do as part of the study.
How do I know if I am a candidate?
There are some basic criteria you have to meet to be part of the study.

• Between 21 and 65 years of age.
• You must not be pregnant or nursing or plan to become pregnant when you enter the study
• If you have had breast cancer, you must be cancer-free for at least 5 years.
• You must not have breast implants
• You must be covered by health insurance

What are my options? Must I have stem cell enriched fat?
The study has 3 options and the one you enter is your choice.
The first option is to have the stem cell enriched fat procedure as described above.
The second option is to have plain fat augmentation. The process is the same as the stem cell procedure except that stem cells will not be separated from you fat and added back. You will just have fat taken from your abdomen, thighs or buttocks and injected into your breasts.

[Paula O]

It's great to be able to pool info. Thanks.

It sounds like some mastectomy patients have a hard time maintaining suction with the BRAVA (versus those with breasts seeking enlargement) and have to be very careful about skin integrity during that phase.

I wonder how the risk of fat necrosis compares with the trans flap procedure.

Just briefly glimpsed at these two links--

http://www.scienceinpublic.com.au/st...econstruction/
Neopec is currently in clinical trial with humans. It involves the placement of a biodegradable chamber within the breast pocket, along with some fat stem cells and veins.

http://www.fatgraftpatients.com/forums/
Here's a forum for BRAVA fat graft patients worth investigating.

['lizbeth]

I lost a significant part of my TRAM, that is why I'm interested in the lipotransfer.

[Paula O]

Some surgeons offering BRAVA + AFT (Autologous Fat Transfer)
(CONFIRMED - by established patients)

1. Roger K. Khouri, MD, FACS
Miami Breast Center
580 Crandon BLVD.
Key Biscayne, FL 33149
305-365-5595
305-365-5516 (fax)
info@miamibreastcenter.com
Dr. Khouri's license verification

2. Christina Ahn, MD, FACS
NYC Breast Reconstruction Center
630 3RD AVENUE
(3rd Ave/40TH ST)
SUITE 601
New York, NY 10017
212-717-8860
347-342-4955 (fax)
ahnclinic@hotmail.com
Dr. Ahn's license verification and disciplinary action search (none)


3. Daniel Del Vecchio, MD
Boston Breast Center
38 Newbury Street
Fifth Floor
Boston, MA 02116
617-262-8528
877-323-EASY
671-262-2256 (fax)
info@bostonbreastcenter.org
Dr. DelVecchio's license verification


4. Robert E. H. Ferguson, Jr, MD
Intermountain Medical Group - Plastic Surgery Center — Cancer Reconstruction
(Fat Grafting Information)
5169 Cottonwood Street, #410
Eccles Outpatient Center
Murray, Utah 84107
801-507-1650
801-507-1625 (fax)
Dr. Ferguson's license verification


5. Lauren Greenberg M.D.
Lauren Greenberg, M.D. - website and blog
750 Welch Road, Suite 117
Palo Alto, CA 94304
650-617-9907
650-617-9909 (fax)
Contact info (click here)
Dr. Greenberg's license verification


6. Jeffrey Hartog, M.D.
The Bougainvillea Clinique
4355 Bear Gully Road
Winter Park, FL 32792
407-678-3116
Contact info (click here)
Dr. Hartog's license verification
Fat Banking


7. Kamran Khoobehi, M.D.
Khoobehi
3901 Veterans Blvd
Metairie, LA 70002
(504) 273-7267
Dr. Khoobehi's license verification
*Additional info:
- Fat Graft Forum
- Fat Banking


It took a couple days for activation as a prospective patient new member of the http://www.fatgraftpatients.com/forums/
site (where this list came from) but that forum is a wealth of info for potential patients and those undergoing the procedure. Under each of the above doctors, there is a list of women who are being cared for by them, sharing their experiences.

Paula

[jaykay]

It sounds interesting but I'd be a little afraid of the stem cells. They are growth factors. Has enough research and follow-up been done on bc patients?

Janis

[Midwest Alice]

Paula this is very interesting I just finished the traditional method . I am here getting my Herceptin and just 2 week out from the last of my reconstruction surgery. I have implants and they feel natural , I really like how I look in clothes.

[Joanne S]

hmmm? none of the links for miamabreastcenter work.

[Paula O]

Hi Joanne,

I guess they were having problems with their website when you tried. It's back up now.

Have a great day,

Paula

[mmoons]

Hi all-

So funny...I was popping in tonight to tell you all that I am meeting with the Miami Breast Center on Monday morning.

I have been researching like crazy about this. It has taken me nearly 4 years to do anything, mostly because I did not want any of the flap procedures. To hard as a single mom.

In my initial call with them, they were very clear that it is a long process. There is no overnight solution. I am going to go into this with a healthy skeptisism. All I want are large A's or small B's....something on my otherwise pancake flat (concave) chest. Just so I can wear t-shirts without the self conciousness.

Here is a review of the procedure/trial from the Journal of Plastic Surgery.
http://journals.lww.com/plasreconsur...&autoPlay=true

I promise to report back what I learn!!

Maureen