Tissue Expansion before Breast Augmentation with Fat Grafting

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Tissue expansion with an external expander can increase the survival rate and therefore predictability of breast augmentation with fat grafting, according to a study published in the upcoming issue of the Journal of Plastic and Reconstructive surgery, the official journal of the American Society of Plastic Surgeons. Fat grafting seems for many women to be a valuable alternative to using breast implants for breast augmentation, but the technique is not yet ready to provide reliable, predictable results the way that using breast implants does. One problem with using fat grafting for breast augmentation is that not all the transplanted fat survives, resulting in significantly less volume than intended. Worse, because it can be hard to predict how much fat will survive transplanting, surgeons and patients don’t know what to expect from the procedure, and when transplanted fat dies, it can result in an uneven volume or irregular surface. To solve this problem, researchers are continuing to explore the use of an external tissue expander to prepare the breasts to receive the graft. The external tissue expander, known commercially as Brava, consists of two vacuum domes that are placed over the breasts and pump out the air to pull on the breasts until they increase in size. Without additional tissue, expanded breasts may shrink in size, but in theory fat grafting allows the placement of additional volume that maintains the size of the expanded breasts. In turn, expanding the breasts before fat grafting may reduce stress on grafted tissue to increase survival rates. In the published study, 84 patients underwent the combination of pre-graft expansion and then grafting, of which 81 complied with study protocols and were available for analysis. These 81 women experienced survival rates of 82±18 percent, compared to the baseline survival rate of 55±18 percent taken from six recent studies on breast augmentation using fat grafting. Although excluded from the final results, the researchers also found that smaller grafts tended to have better survival rates. Initial grafts were smaller, about 190 ml of fat per breast, and had very high survival rates, about 90%. Later grafts were larger, about 360 ml, with lower survival rates, about 78%. Follow-up scans were taken at 3, 6, and 12 months after grafting, and showed that fat surviving to the 3-month mark tended to be stable out to a year, which researchers postulated might represent permanent results. This study is promising, but shows that breast augmentation with fat grafting still has several important obstacles to overcome before it is ready for widespread use. To learn more about breast augmentation available today, please contact Dr. David A. Bottger in Philadelphia for a consultation.