Q: Dr. Eppley, I had fat injection breast augmentation done six months that had a lot of problems afterward. There was drainage from under the left breast for three weeks after the procedure. I was put on antibiotics to treat it but was told the rubbing of my bra on it was the cause. Then a month later my right breast developed a large painful lump that turned out to be an abscess which required more antibiotics and needle drainage. I am now left with one breast bigger than the other and one of them is lumpy. The doctor now wants to do the procedure again but this time using the Brava device. Will this make a difference and make it more likely that the fat grafts will take? My doctor is an ObGyn who specializes in cosmetic surgery but my first experience has now made me nervous.
A: Unlike breast implants, the use of fat injections for breast augmentation is not an assured outcome. As you know and have experienced, the take of injected fat is subject to a wide variety of factors not all of which is completely understood. The take of injected fat is highly dependent on the harvesting, method of preparation and the injection technique. While the injection of fat seems like, just like the liposuction of fat, successful results ultimately depend on surgeon experience and attention to technique details.
The concept of using the Brava device is a good initial approach for small breasts with a tight skin envelope. Whether that would have been advised for your first fat grafting surgery is now irrelevant but should probably be considered for any second stage. But it is important to remember that the Brava device is an adjunctive procedure to prepare the recipient breast bed, it is not the magical solution or a substitute for adhering to sound fat graft harvest, preparation and injection principles.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in fat injection breast augmentation. I have a consultation coming up with you next week and was wondering if you use the Brava before fat transfer for breast expansion? I was wanting to get into surgery ASAP as I am going on vacation next month and want the surgery prior to the trip. If I have to wear the Brava, I won’t be able to get the surgery done before the trip and be healed enough to wear a bathing suit. Also, I would prefer conscious sedation to a general if you do that.
A: If your goal is to have a completed fat injection breast augmentation within the next thirty days, that is not an achievable goal. Breast augmentation by fat injections, if you are a good candidate (and most people aren’t) requires 3 to 4 weeks of presurgical breast stimulation by the Brava device followed by a similar time period after surgery of use of the device. This is an optimal device, even though it is inconvenient, as it provides stimulation to the breast tissue and the injected fat so that its survival is optimized. Thus you can quickly see that is not going to work by your desired schedule. The only way that time period works to enjoy the benefits of breast augmentation by your vacation is the placement of breast implants. In either case, however, both are best done under general anesthesia. Successful breast augmentation, by any method, is not something to be done under local or sedation anesthesia without suffering a suboptimal result.
Dr. Barry Eppley