Breast Reconstruction and Augmentation With Brava Enhanced Autologous Fat Micro Grafting
Condition: Mammaplasty; Mastectomy; Lumpectomy
Study type: Interventional

Summary: 
      The primary objectives of this study is to determine whether use of a negative pressure
      external soft-tissue expansion system pre-operatively and post-operatively improves and
      secures graft survival in autologous fat micro grafting breast augmentation and
      reconstruction procedures.
    

Detailed description: 
      Procedure:

      Urine pregnancy test will be performed before each designated procedure in the study.
      Patients will be questioned about underlying renal disease and excluded if existent.

      Pre-operative/baseline digital or 35mm photos will be obtained utilizing the standard
      criteria as performed routinely by plastic and reconstructive surgeons before any surgical
      procedure. Oblique, frontal and sagittal views will be stored in protected files.

      Optional: Patients will have a preoperative breast MRI with the contrasting agent Gadolinium,
      utilizing a 1.5 Tesla MRI machine and breast coils unless status post breast cancer where no
      pre-operative MRI is needed. All readings will be performed by board certified radiologists.

      Brava domes will be worn bilaterally 3-4 weeks before surgery for 10-12 hours per day, 7 days
      a week with 24 hour wear for the final 72 hours (3 days) before surgery. Patients will be
      required to adhere to the dome cleaning process specified by the manufacturer. This is
      prudent for hygienic reasons and to reduce skin irritation and infections. The domes are for
      single patient use only. Pressure will range from 15 mmHg to 105mmHg and will be achieved and
      regulated by either SmartBox, bulb syringe and/or Brava Turbo devices. This will open up the
      tissue planes and maximally expand the recipient breast in preparation for graft insertion.

      Institutional Review Board approval will be obtained and all patients will be properly
      advised of their rights via signed Informed Consents.

      All patients will be assessed by board certified plastic and reconstructive surgeons for
      autologous fat harvesting sites. Preoperative sedation with IV sedation and/or oral sedation
      is recommended. Preoperative antibiotics, such as Keflex or similar drug, will be
      administered before surgery. Sterile drape and prep of the fat harvesting sites will be
      carried out.

      Tumescent anesthetic solution will be prepared by diluting 50cc's of 1% lidocaine with
      1/100,000 units of epinephrine with 1000cc's of Ringers Lactate solution and will be
      instilled with a 14-gauge infusion infiltration cannula into the areas of fat harvesting.

      Gentle, low vacuum pressure manual liposuction will be performed to avoid damaging the fat
      cells. Liposuction will be performed in a standard fashion using 12G & 12 side holes
      harvesting cannulas and connected to syringes that maintain a controlled constant low vacuum
      pressure of 300 mmHg (preferably using the K-VAC (Vacuum Assisted Device) syringe). The
      aspirate will be purged from the syringes into collection bags using atraumatic nonclogging
      valves (preferably the AT-Valve) or 3 way stopcocks. Once filled, the bags will be spun at
      low speed (<1000 rpm) to separate fat from serum (and free of oil, if any). The infranatant
      serum will be drained and the cellular fat supernatant will be concentrated in the bags and
      directly re-injected into the breasts. Depending upon the volume correction required and the
      recipient space available, 100 to 500 ml of gently centrifuged (non-packed) fat will be
      injected per breast.

      The recipient breast will be marked carefully prior to infiltration of anesthetics to
      determine the preferred graft distribution pattern and to select 9-18 graft insertion sites
      (circumareolar, inframammary, axillary and at the circumference of the breast). The skin will
      be infiltrated at the graft insertion sites with Naropin 2% (ropivacine).

      After the recipient site is anesthetized, puncture sites will be made with a 14-gauge needle.
      A 14-gauge blunt tip cannula or similar cannula connected to a 3 ml syringe is used to gently
      inject small droplets distally first and then subsequently proximally as the cannula is
      withdrawn. Repeated passes at multiple levels in a radial fashion are performed through each
      of the puncture sites such that the grafts droplets are laid down in a criss-crossing pattern
      and at multiple planes. Avoid the glandular tissue by remaining in the subcutaneous plane and
      if more volume is needed and is available proceed to fill the subglandular, intramuscular and
      submuscular planes. Incision sites are covered with sterile band aids applied to skin. Gentle
      conforming dressings will be applied to breast.

      Elastic garments will be placed on harvest site. Postoperative instructions are handed to
      each patient. Patient will begin wearing the Brava System, with the SmartBox device only, 18
      hours post-operative as a stabilization device. For the first three (3) days the system is
      worn 24 hours a day or as to the maximum tolerated. If the patient notes pain, the system may
      be removed and replaced a few hours later. The System is then worn 10 to 12 hours a day for
      one additional week (7 days). Then the patient may choose to proceed with a prolonged
      intermittent wear of 10 hours per day for 10 - 14 weeks.

      Follow-up will include: A call from the surgical team within 24 hours after surgery. An
      office follow up visit within 48-72 hours of surgery and follow-up appointment in 6 months.
      More office follow up visits in the interim are recommended but not mandatory.

      A one-year post grafting mammogram will be recommended to all women over the age of 40.
    

Intervention name(s): Brava Autologous Fat Transfer System
Intervention type(s): Device
Intervention description(s): Number of procedures is based on patient need
Other intervention name(s): Brava System
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Fat Grafting; Breast Augmentation; Liposuctioned Fat Transfer; Lumpectomy; Mastectomy; Micromastia; Asymmetry; Post Lumpectomy Filling Defects; Post implant removal filling defect; Post Mastectomy; Autologous Fat Transfer; Tubular breasts; Tuberous breasts; Constricted breasts