Do You Provide the BRAVA and AFT Procedure?

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I am a breast cancer patient who has recently finished chemotherapy. I am looking now into reconstruction, but I was wondering if you performed the BRAVA+AFT procedure?

A: We are actively looking into BRAVA and AFT, but not doing it yet. I would suggest you contact Dr. Khouri, he’s certainly the expert at this point. If you should need GAPs, PAPs, or DIEPs, we would be happy to help you.


Q: I recently finished 8 weeks of chemotherapy. I did not have radiation. I still have Herceptin until next May. I understand you do not currently offer BRAVA, but I’m interested in a fat transfer. Do you use expanders or something? I really want to have something done sooner than later but am willing to wait if it’s necessary. Could you explain to me the procedures you recommend?

A: I would not recommend fat transfer alone as a breast reconstruction technique without BRAVA. Even with BRAVA, it will probably take several sessions to get to the size you want, and there is still no guarantee that it will ultimately be successful, as fat survival is not strictly predictable.

We primarily offer microsurgical breast reconstruction (DIEP, sGAP, PAP), we do it on an almost daily basis, and our flap survival rate over the last 10 years (98.4 %) is realistically probably as high as anyone’s. However, we realize that this is not for everyone. If you have not had radiation, implants may well be a good option for you, and there is likely no need for you to travel a long distance for this, as most communities of any size have plastic surgeons skilled in this area.

Any type of reconstruction can usually be done in between Herceptin treatments, although we ultimately defer to your oncologist’s advice on this.  If you live near us and want an opinion, we’ll be happy to see you in consultation at any time.

Hope this helps!

Dr. Richard M. Kline

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Breast Implant Alternatives to Adding Volume, Shape, and Projection to a Breast

charleston breast surgeonsThe below question is answered by Charleston breast surgeon, Dr. Richard M. Kline, Jr. of The Center for Natural Breast Reconstruction:

In July 2010 I had I-GAP reconstruction. The results are awful. Do you have techniques that can work with a flap and add volume, shape, and projection to a partially recreated breast without the use of implants?

Sorry to hear about your problem, but it’s not terribly unusual to not have quite enough tissue after flap reconstruction. That’s actually good for you, because it means we have some experience dealing with this. The most desirable techniques to try, and in what order, depend on your body type and preferences, but here are some options:

1) Fat grafts: Your fat from anywhere you don’t want it can be harvested with liposuction and injected into the breast mounds in the desired areas. Survival of the fat is not strictly predictable, but often a significant amount remains permanently. Several sessions may be required, however.

2) Vth intercostal artery perforator flap: This is a fancy name we give when we utilize the extra roll of skin and fat that a lot of patients have (& hate) on the side of their chest behind the breast, under the armpit. It is left attached at the front, the skin is removed, and the flap is tunneled under the skin at the side of the breast, then across the top of the breast as far as it will reach. Besides making the breast bigger, this technique has the particular advantages of covering the upper border of the pectoralis muscle (often visible just under the skin after reconstruction), and lifting the breast in what is often a very aesthetically pleasing way. The disadvantage is that it adds a scar under the arm from where the flap was taken.

3) Additional perforator flaps: No one likes to hear this, but sometimes it is the best answer. We have always been able to find suitable blood vessels and add flaps successfully whenever we have had to try this, and the results have been favorable. Definitely not the first choice for most people, but good to know it’s a tried-and-true technique if you absolutely need it.

4) Finally, a small implant under a too small but otherwise healthy flap is often surprisingly well-tolerated, even in radiated patients. Not for everyone, but an option that has been used quite successfully in some instances, nonetheless.

We went through our “iGAP phase” some years ago, and abandoned it not because of the reconstructive results, but because we decided the sGAP donor site resulted in far more favorable buttock aesthetics.

–Dr. Richard M. Kline, Jr.

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