Forget your old notions about breast reconstruction after a mastectomy. Thanks to a new method, what was once a long and arduous endeavor requiring multiple surgeries, protracted recovery time and, for some, complications such as implant hardening can now be a scalpel-free process with little recovery time.

Brava, pioneered by Miami plastic surgeon Dr. Roger Khouri, uses liposuction to transfer fat from a woman’s hips, thighs, or stomach to her breast area, which is prepped for the process with a large suction-cup bra (also called Brava) that expands external skin, loosens scars, and creates a small pocket and new blood vessels. Once that pocket is created, the surgeon fills it with tiny injections of fat from the stomach, hips, thighs, etc., which then feed off the newly created blood vessels. 

“I consider it a potential breakthrough,” says Dr. Frank Isik of the Polyclinc in Seattle—who has more than 15 years of breast reconstruction experience using traditional methods such as tissue expanders, implants, and “flap” procedures, which harvest tissue and/or muscle from a woman’s stomach or back to surgically create new breasts, and has worked with 10 patients using Brava. “It’s a very natural reconstructive method, and the recovery period is nowhere near as lengthy as the other methods. Plus it isn’t as invasive, doesn’t have extensive scars, and there’s not a long recovery period.”

Along with more realistic feeling breasts, Brava’s benefits include body-contouring results from the liposuction and, according to three of Isik’s patients, more sensation. 

“The real minus with it is the onerous aspect of wearing the [Brava] device,” Isik says. “It’s cumbersome, it causes rashes, and patients need to wear it for several weeks before and after each procedure.”

Patients opting for this type of fat-transfer reconstruction also have to undergo at least three procedures to get an A or B cup breast. A small C cup might require up to four or five sessions. 

While reserved about the new procedure at first, Isik is now offering it to all qualifying breast reconstruction patients by enrolling them in an ongoing clinical trial, and two surgeons at the Plastic and Reconstructive Surgery Clinic at the UW Medical Center are performing this type of reconstruction, as well.

For women who prefer more traditional reconstruction—or for those interested in breast enhancement—Isik says the latest advancement is cohesive gel implants, also known as “gummy bear” implants.

“Currently, implants are silicone gel,” he says. “There’s a hard membrane on the outside but more of a gelatinous nature—like Jell-O—on the inside. If the outer membrane does rupture, it stays together but it is fluid.”

These new “gummy bear” models, however, are more stable.

“They are far less likely to rupture, and if they are ruptured, they are far less likely to distort their shape,” Isik says. “We think this is a significant improvement over the current technology in silicone implants, but results of ongoing clinical studies will demonstrate their benefits.”

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