When Adrienne Reed was diagnosed with breast cancer in 2010, she didn’t have much choice but to go ahead with the traditional double mastectomy and chemotherapy. When it came to reconstructing her breasts, though, the 39-year-old Seattle piano instructor went a different route.
“What I gleaned from my research was that all implants require changing — like tires — and general anesthesia and probably three surgeries would be required,” she says. “I was looking for something more natural and less traumatic.”
Reed found it with a technique known as Brava/AFT (autologous fat transfer), a unique method for both breast augmentation and reconstruction featured in the May issue of Plastic and Reconstructive Surgery, the official journal of the American Society for Plastic Surgeons (ASPS).
The six-year study, which focused on breast augmentation only, presented results of Brava/AFT on 81 patients. According to its conclusion, the method “led to significantly larger breast augmentations, with more fat graft placement, higher graft survival rates and minimal graft necrosis or complications.”
This is big news in the world of breasts for a couple of different reasons. First, breast enlargement via fat transfer or fat grafting was essentially banned by the ASPS 25 years ago.
“It was beyond controversial,” says Dr. Roger Khouri, a Miami plastic surgeon and lead author of the study. “In 1987, they issued a very strong statement that said fat grafting was not recommended for anybody” due to minimal results, unpredictable results and the inability of radiologists to distinguish fat nodules from cancer.
Since then, however, the new research suggests Khouri and others have ironed out the bugs, creating a new way to augment breasts.
More than that, they’ve created a third option for women who’ve undergone mastectomy, particularly women like Reed, who want breasts, but prefer not to go through another major surgery and/or deal with implants.
In a nutshell, cancer survivors are now able to “grow” new girls.
Reconstruction zone
A far cry from your average “boob job,” the most common type of breast reconstruction involves tissue expanders which are surgically placed behind the patient’s chest wall, then slowly filled with saline over a period of weeks. Once the skin and muscle are adequately stretched, the devices are surgically swapped for either saline or silicone implants.
Not all women are candidates for this method, though, which is where “flaps” come in. In these procedures, skin, muscle, fat and sometimes blood vessels are nipped from one part of the body and tucked into the breast area, creating a fleshy pocket. That pocket is then filled with the patient’s own tissue or fitted with an implant. Tram flaps and DIEP flaps harvest from the stomach; lat flaps from the back and “free flaps” from areas like the inner thigh or buttocks.
In Brava/AFT, however, the patient’s fat is harvested with liposuction as opposed to a scalpel, then injected into the breast area. But not before the area’s been prepped with an external tissue expander known as the Brava, a suction-pump bra that looks like something you might find in Madonna’s costume closet.
“It’s definitely a cumbersome device and patients have to be willing to commit to it,” says Dr. Frank Isik, a Seattle plastic surgeon who’s currently doing a clinical trial on Brava/AFT. “Some patients look at it and say, ‘This is not for me.'”
Others, like Reed, eagerly embrace a reconstruction method that requires far less surgery and involves far less recovery time, despite the burden of wearing a “Brunhilda bra” 12 hours a day for six or more weeks.
“The first time I put it on, I was too embarrassed to go out,” says Reed of the device that she wore — usually to bed — before and after each of her three AFT procedures. “I’m 5’2″ and it’s like a size EEE bra. But that’s not what it’s about. I kept my eye on the prize.”
Khouri, lead author of the study and creator of the Brava, readily admits his device — originally developed and FDA-approved for breast augmentation alone — looks and sounds a bit laughable.
“Suction bras have been in shady catalogs for more than 100 years,” he says.
But the science behind the invention is solid, he adds.
“We are able to regenerate breasts,” says the plastic surgeon, who’s reconstructed breasts on more than 200 women using Brava/AFT and hundreds more using traditional surgeries. “The holy grail of tissue engineering is a vascular scaffold — a capillary network. The Brava creates the scaffold by pulling on the tissue from the outside. Then liposuctioned fat fills that scaffold with cells. We’re regenerating an organ without any incision, without any foreign object, without any chemicals.”
Not only that, the procedure comes with a sweet side effect.
“Many patients don’t want implants or the major surgery associated with a tram or DIEP flap,” says Isik, who’s performed Brava/AFT on five women so far. “And some patients don’t have the fat in the right spot. The beauty of this method is that it allows body sculpting to be done. It doesn’t matter where you have excess fat — the belly, the back, or the thighs.”
Liposuction isn’t painless, though.
“The best way to describe it is you feel like you’ve been hit by a truck,” says Jeanne Reid, a 58-year-old retired teacher and breast cancer survivor from Naples, Fla., who in a series of five procedures had fat removed from her stomach, thighs, and lower back to create new breasts. “But my down time was very little. I was walking immediately and back to playing tennis within two to three weeks.”
As with all surgical procedures, there can also be complications — primarily nodules and cysts — but Khouri says he’s found these to be “minimal,” a far cry from fat transfer procedures of the late 1980s which were banned by the ASPS due to the frequent lumps and bumps that required biopsies.
“With today’s technology, that’s not an issue,” says Khouri. “Radiologists now have ultrasound and better mammography and MRI. These tools help them recognize what is cancer and what is not cancer and they’ve brought down the rate of biopsies.”
Fat graft survival rates are better these days, as well, thanks to the “vascular scaffold” — or blood supply — created by the external tissue expander.
Michigan-based plastic surgeon Dr. Tony Youn says he considers this method a great addition to the breast reconstruction arsenal, but does raise the question of Khouri’s financial interest in the device. (According to the study’s disclosure statement, Khouri has an “equity interest” in the Brava device.)
“That definitely poses a conflict of interest,” says Youn. “Although Dr. Khouri has always been upfront about his relationship to the company.”
For patients like Reed, though, that’s a non-issue, especially since the Brava/AFT technique seems to come with an added bonus — the return of sensation, something lost after mastectomy.
“The morning after I wore the Brava, the sensation on my chest started to return,” says Reed, who’s “ecstatic” about her new breasts. “I stood in front of the mirror and just cried because I could feel my chest and that meant everything to me.”