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The ultimate dream of enhancing the volume and shape of a female breast would be to do it naturally and without any marks. Magic? No more. Plastic surgery is closer to this ideal today than ever before. Read on to know more…

A few disclaimers first! It must be stated at the outset that, as of 2014, breast augmentation by silicone implant is still the gold standard and well-accepted method. Fat grafting is a relatively new method that is gaining global acceptance as a natural and non-implant option. Not all women are good candidates for this method but a vast majority can consider this method. Combining fat grafting with implants in the form of composite breast augmentation is another exciting concept. In my practice at least, it is offered to all suitable candidates as one of the options to consider. It is then left to the lady to choose.

Some basic breast facts: A woman’s breast basically consists of gland tissue and fat. Both of these increase in volume with the onset of puberty. Women that have a small breast usually are deficient in the fatty component more that the glandular. Fat is usually the major component especially in the larger breast. So it is logical that fat can enhance the breast size. However until recently fat grafting or the act of transferring more fat to the breast was not even considered as possible or suitable. The fact that this method has come so late in medical science is actually surprising. There are several valid reasons for this. Firstly there was no predictable way of transferring large volumes of fat by a simple method. The grafted fat seemed to disappear after some time. The safety of doing this in breast, an organ at risk of breast cancer, has also kept surgeons wary of doing it in the breast. Finally, the fact that only modest increase in size achievable made fat grafting a poor competitor to implant based enhancement.

What has changed? The success associated with breast fat grafting has changed now due to two recent advances. The first advance is the BRAVA, an innovation attributed to the pioneering work of Dr. Roger Khoury from Florida. This is a device that the woman wears outside her breast like a large bra; the difference is that it is an active Bra which creates vacuum inside it. The BRAVA consists of two hard clear plastic domes with soft gel rims, held in place over the breasts with a bra like garment. The domes are attached to a small cell-phone sized gadget that creates controlled vacuum inside the Brava. Due to the vacuum the breasts get ‘pulled’ out or drawn out. This is not painful. This enhances the blood flow and leads to creation of new tissues inside the breasts. But the down side is that it has to be used for at least 10 hours per day for 4 weeks; the final increase in size is 0.5 to 1.0 cup size when used by itself. The second advance is the microfat grafting method popularized by Dr. Sydney Coleman and others. Gentler methods are used to harvest micropackets of fat which are then distributed and spread out evenly in the given space as small droplets; this way of grafting assures a greater survival of the grafts.

Combining the two methods has been the real kicker. In Brava assisted fat grafting, the Brava device is used for one month to improve the blood supply and draw out the tissues, thereby creating space for the microfat grafting which is done a month later. For another month following this, the woman has to use the BRAVA again. In this way, a remarkable enhancement is possible. But it may still fall short of what an implant can achieve. A second session may be required 6 months later in the majority of subjects to get a ‘wow’ effect. Many women may however be satisfied with one session.

Fat grafting vs implant enhancement of breasts:

Breast fat grafting is fundamentally different from implant surgery. This is a ‘living’ enhancement and is capable of growth in future. The advantages are many:

  1. Natural enhancement without any need to change an implant in future
  2. Ability of this fat graft to grow in case of weight gain
  3. Simultaneous improvement in the donor areas where fat was taken from
  4. Soft breasts
  5. No scars.

On the flip side of the coin, here are the downsides:

  1. Long and slightly tedious preparation time needed with Brava usage.
  2. For the hours that she uses the Brava, she cannot go out socially as the domes are a bit large and ‘visible’.
  3. Needs a conducive environment at home/living quarters for the woman to be able to wear the device for 2 months from evening to morning everyday
  4. Not all women have enough fat in donor areas, so the method is not suitable for real skinny women. However, many apparently slim women may actually have sufficient fat if all areas are taken together.
  5. The extent of enlargement even with Brava in one session may fall short of the woman’s expectations, especially if she wants to go big.

Safety concerns: A natural concern of all doctors was to know whether this fat grafting can interfere with cancer detection or if it can itself encourage cancer growth. After a lot of careful study, at present fat grafting is considered safe from both aspects. However the radiologist interpreting any future mammograms needs to know that fat grafting was done in the past so that the images can be properly interpreted.

My practice with fat grafting: This method of breast enhancement has been inducted into my practice in 2006 and my preliminary experience is very encouraging. At the moment the woman has to order the Brava from the US, we will of course assist with information and measurements for the order form. We will assist in the correct usage of the device. The fat grafting will be done after 1 month of preparation period. I mix the fat with platelet rich plasma [PRP] to further enhance the success rate. We carefully assess the person to enhance not only her breasts but simultaneously address her “problem” areas of fat excess so that a bonus of improvement in these areas is also attained.

The Future: We hope that current and future research will make the procedure more predictable, and include the use of methods to concentrate the stem cells contained in the fat graft. It may be possible to achieve the entire enhancement in one session rather that two. It may become possible to also speed up the procedure which currently needs a lot of time and commitment from the patient and surgeon.