Treating Breast Conservation Therapy Defects with Brava and Fat Grafting: Technique, Outcomes, and Safety Profile.

Abstract

Sir: We read with great interest the article entitled “Treating Breast Conservation Therapy Defects with Brava and Fat Grafting: Technique, Outcomes, and Safety Profile” by Bucky et al.1 in Plastic and Reconstructive Surgery. The authors presented the safety and clinical outcomes of Brava (Brava LLC, Miami, Fla.)/fat grafting following breast conservation therapy. We appreciate this innovative work and want to share some questions with the authors. In this study, the authors performed external expansion for 5 weeks, based on the collective anecdotal experience, before performing fat grafting, which is much longer than the protocol in breast augmentation. As is known to us, the longer duration of Brava use may increase discomfort and may cause skin complications such as dermatitis. We want to know whether this type of complication occurred during treatment. In addition, the authors did not mention the treatment duration of Brava treatment after fat grafting. It would be more appropriate to mention whether the duration of Brava use after fat grafting is the same as the protocol in breast augmentation. This study stated that patients who underwent Brava preexpansion had a significantly higher initial fill volume compared with those who did not (219 cc versus 51 cc). However, the preoperative degree of defect may also influence the amount of fat grafting. It would be more appropriate to provide the information regarding the degree of preoperative defect for the two groups. It had been speculated that an interval greater than 24 months from radiation therapy to lipofilling may be protective against locoregional cancer recurrence. In addition to considering oncologic recurrence, the problem of skin intolerance should also be considered, as radiotherapy may damage the vascularization of related skin. We want to know whether there is a minimum interval from radiation therapy to preexpansion to decrease the rate of skin complications. In addition, fat was harvested by means of continuous suction at high pressure (−750 mmHg), which might be helpful for harvesting an adequate amount of fat but might be traumatic to adipocytes.2 We would appreciate if the authors could explain their reason for using high-pressure suction. In conclusion, the authors presented a pilot study using Brava preexpansion to treat defects after breast conservation therapy. We expect further long-term, large-sample studies that provide more specific information in the future. DISCLOSURE The authors have no financial interest to declare in relation to content of this study. No funding was received for this communication. Shangshan Li, M.D.Jie Luan, M.D.Department of Aesthetic and Reconstructive Breast SurgeryPlastic Surgery HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijing, People’s Republic of China