Unique cosmetic surgery moves body fat to breasts

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."

Bumps and benefits
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."

Related:

Diane Mapes is a frequent contributor at msnbc.com and TODAY.com. She's also the author of "How to Date in a Post-Dating World" and writes the breast cancer blog, doublewhammied.com.

Discuss this post

Jump to discussion page: 1 2

Ouch! This must be what men feel like when surgery on their privates is discussed in public. Yikes!

    Reply#1 - Fri Jun 22, 2012 11:10 AM EDT

    Please tell me that health insurance is not paying for this unnecessary cosmetic surgery. That would be criminal, and every bit as bad as sewing on a prosthetic penis for men. Its OK if you are paying, but if not, get over it. If you can't then you need mental help, not surgery.

    • 1 vote
    #1.1 - Fri Jun 22, 2012 2:36 PM EDT

    bloggit, if you read the article carefully they are talking about cancer survivors who have had mastectomies.

    • 13 votes
    #1.2 - Fri Jun 22, 2012 3:15 PM EDT

    Bloggit seems like the type that would not care if it is a surgery for reconstruction. I'm glad this is available to women now, It will do a lot of good. And I hope like hell the insurance companies will pay for it.

    • 10 votes
    #1.3 - Fri Jun 22, 2012 4:03 PM EDT

    If you lose half your face but can still eat, drink and talk but could have surgery to improve your looks Bloggit would say its unnecessary. What an ass..........

    • 8 votes
    #1.4 - Sat Jun 23, 2012 9:15 AM EDT

    bloggit

    Please tell me that health insurance is not paying for this unnecessary cosmetic surgery....

    bloggit,

    Your post is callous.

    The patients in this article have breast Cancer.

    The patients are having this specialized surgery to reconstruct their breast.

    Studies have shown, and it is common sense, to know that there is a mind/body connection in the process of treating and healing diseases. A surgeon can perform a mastectomy on a woman. However, with a significant part of her body removed, do you really think that she will experience the best mental and physical results? The goal of this procedure is to help these patients be their best, again. This surgery should not be considered purely cosmetic...but step 2 in helping these patients have the best recovery that is possible.

    • 3 votes
    #1.5 - Sat Jun 23, 2012 6:04 PM EDT
    Reply

    This is wonderful! Talk about killing two birds with one stone. Get rid of unwanted fat in one place and put it in a place where it IS wanted!!! Fabulous!!!

    • 21 votes
    Reply#2 - Fri Jun 22, 2012 11:10 AM EDT

    Very cool- especially for reconstructive. If I ever needed it I'd certainly try for a method that didn't leave plastic and/or silicone in my body.

    • 7 votes
    Reply#3 - Fri Jun 22, 2012 11:13 AM EDT

    This sure sounds preferable to the flap. I once cared for a patient who had reconstruction with a flap from

    her buttocks - it was my one & only occasion to work with leaches in my nursing career. Unfortunately, they were unable to help restore circulation to the area & it had to be removed. I'm a breast cancer survivor myself, but opted not to have reconstruction - I might have agreed to this kind.

    • 9 votes
    Reply#4 - Fri Jun 22, 2012 11:19 AM EDT
    Comment author avatarMrKarnesExpand Comment Comment collapsed by the community

    That's great for women, but can they move some of my fat to my d1ck?

      Reply#5 - Fri Jun 22, 2012 11:29 AM EDT

      There's alway one pig walking among the sheep.

      • 9 votes
      #5.1 - Fri Jun 22, 2012 11:53 AM EDT

      So you say that boob augmentation is okay, but penis augmentation is not? WHY?

        #5.2 - Fri Jun 22, 2012 1:50 PM EDT

        Because he was using vulgar language...he was acting like the appendage he was speaking of. That's why. And if something like this could be used to help a man who had damage to his penis restore function, I don't see why it would be a problem. Sexual health is good for everyone. No one should be not functioning if it can be helped. Unless you are a molester, then I would prefer non functioning...VERY non-functioning.

        • 2 votes
        #5.3 - Fri Jun 22, 2012 4:06 PM EDT

        Lol! pu$$ies!!!!

          #5.4 - Mon Jun 25, 2012 3:36 PM EDT
          Reply

          Great story. Makes perfect sense if this can be done without risks or unnecessary complications.

          • 4 votes
          Reply#6 - Fri Jun 22, 2012 11:40 AM EDT

          This is fantastic for breast cancer survivors who feel they need to reform their chests. Even better that it helps bring back sensation.

          • 5 votes
          Reply#7 - Fri Jun 22, 2012 11:42 AM EDT

          Another major advance in the art of modifying the human body. Any woman who needs reconstruction or just wants bigger boobs ought to give this procedure serious consideration. The method ought to get evaluated for all augmentation surgeries.

          • 2 votes
          Reply#8 - Fri Jun 22, 2012 11:49 AM EDT
          Reply

          Science never ceases to amaze.

          • 3 votes
          Reply#9 - Fri Jun 22, 2012 11:54 AM EDT

          what no pictures of boobs? soo disappointed.

          • 1 vote
          Reply#10 - Fri Jun 22, 2012 12:19 PM EDT

          The irony. Bras cause breast cancer in the first place (yes they do), so lets have people who have already had breast cancer wear a bra for 12 hours a day just so they can have something on their chest that looks like breasts again. Just. Wow.

            Reply#11 - Fri Jun 22, 2012 12:20 PM EDT

            Thanks for the laugh!

            • 11 votes
            #11.1 - Fri Jun 22, 2012 1:00 PM EDT
            Reply

            Do they move the cellulite up to the boobs too?

              Reply#12 - Fri Jun 22, 2012 12:38 PM EDT

              I had a mastectomy done in 2000 and had this procedure. I still do not regret my decision. It was either this or come back when you 70 and have it all done again. It's very natural looking, in movement and feeling. I'm so glad I chose this reconstructive instead of prosthesis. I would do it again no problem.

              • 4 votes
              Reply#13 - Fri Jun 22, 2012 12:47 PM EDT

              Fat grafting to create entire breasts has not been around that long, was your reconstruction more recent?

                #13.1 - Sat Jun 23, 2012 2:02 AM EDT

                Actually, they've been working on this awhile. I remember a story 25 years ago highlighting this type of procedure and they showed a woman who had undergone double mastectomy and reconstruction using belly fat. She was wearing a two piece bikini with the flattest tummy and nicest set. So it has been going on longer than 2000.

                • 2 votes
                #13.2 - Sat Jun 23, 2012 9:11 AM EDT

                Fat grafting and flap surgeries (which skin and tissue and vessels or just tissue and vessels are removed from abdomen, thighs or buttocks) are different. 25 years ago fat grafting was not allowed due to concerns that dead fat would appears to look like breast cancer or it might cause recurrence of breast cancer. Only recently has it been deemed safe.

                  #13.3 - Sun Jun 24, 2012 6:23 PM EDT
                  Reply

                  Just imagine.. if they took Kim Cartrashian's giant a$$ and turned it into ( * Y * )'s... wow!

                    Reply#14 - Fri Jun 22, 2012 1:09 PM EDT

                    I think, provided this works as intended and suffers no catastrophic complications, this is a very good idea for breast cancer survivors. I can, however, see this being used largely for vanity surgeries. Still, it's better than bags being put in your chest, right?

                    • 3 votes
                    Reply#15 - Fri Jun 22, 2012 1:31 PM EDT

                    I wonder if they could put it on my Butt instead I have enough Boobs !! :) :)

                    • 2 votes
                    Reply#16 - Fri Jun 22, 2012 1:32 PM EDT

                    Fat transfer to the buttocks is absolutely an option. This has been increasing in popularity in cosmetic surgery over the last decade and works very well in experienced hands. My colleague, Dr Chad Deal, is a leading expert in buttocks augmentation with fat transfer. We rarely use it for breast augmentation because the results are not impressive and the cost is much higher than with breast implants, but it is an option. For more information check out our website, Thanks!

                      #16.1 - Sat Jun 23, 2012 10:09 AM EDT
                      Reply

                      I hope this will eventually be covered by health insurance when it is part of post-mastectomy reconstruction. It sounds like a great success.

                      • 3 votes
                      Reply#17 - Fri Jun 22, 2012 2:03 PM EDT

                      It is covered by most insurance plans.

                        #17.1 - Sat Jun 23, 2012 2:03 AM EDT

                        The law requires health insurance to cover approved reconstruction; as well it should.

                        • 2 votes
                        #17.2 - Sat Jun 23, 2012 9:12 AM EDT
                        Reply

                        Do they have an equivalent for men????

                          Reply#18 - Fri Jun 22, 2012 2:32 PM EDT

                          Who no comments or articles on "Fast & Furious" or the Andrea Mitchell video fraud?

                            Reply#19 - Fri Jun 22, 2012 2:52 PM EDT

                            to write a artical such as this with no pictures was just plain wrong! i eagarly clicked on the story and had my hopes just dashed!!! i am NOT happy!!!

                              Reply#20 - Fri Jun 22, 2012 2:55 PM EDT
                              Reply

                              I think many members of Congress had similar surgery except the fat was moved to their heads.

                              • 1 vote
                              Reply#21 - Fri Jun 22, 2012 3:23 PM EDT
                                #21.1 - Sat Jun 23, 2012 1:14 AM EDT
                                Reply

                                Hmmm... well that's different.

                                  Reply#22 - Fri Jun 22, 2012 3:44 PM EDT

                                  Suzanne Summers had a breast lumpectomy, then the space filled by fat transfer. You can see her procedure on youtube.

                                  http://www.youtube.com/watch?v=xt55cTQEoHk

                                  The National Enquirer called Summers a liar when she said her liposuction was part of her treatment for breast cancer.

                                    Reply#23 - Sat Jun 23, 2012 1:17 AM EDT

                                    Two birds - one stone. May as well.

                                    • 1 vote
                                    Reply#24 - Sat Jun 23, 2012 1:36 AM EDT

                                    I am in the middle of this for breast reconstruction and know several women who have had this procedure. My breasts are soft and supple and will last a lifetime opposed to implants which expire after 10 years and are full of harmful toxins.

                                    Suzanne Sommers did not have the same procedure. She had stem cell enriched fat grafting which has no better outcome than micro-fat grafting - it just costs A LOT more.

                                    As for bloggit, you are an idiot.

                                    • 1 vote
                                    Reply#25 - Sat Jun 23, 2012 1:58 AM EDT
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