External expander-assisted autologous fat augmentation/breast reconstruction Role of external expander:Pre-operative pre-expansion of breast tissue opens the recipient space, creates vascularization and ensures safe transplantation of large amounts of fat at one time. Postoperatively, the fat grafted breast is fixedly expanded to create nutrition and effectively ensure its survival rate. The increased fat viability means a lower rate of post-operative fat injection calcification, which is safer than traditional fat injection breast augmentation and has less impact on future breast cancer screening. Another surprise for patients is that since autologous fat augmentation requires a larger amount of fat and is usually taken in areas such as the abdomen or buttocks and thighs, breast augmentation and local liposuction can be performed simultaneously. Applicable people:Women between 18 and 60 years of age with the following problems can improve their breast shape and size by using BRAVA external expander. Generally speaking patients with loose breasts have better results than patients with tight breasts. 1.Patients who are not very satisfied with the size of their own breasts; 2.Inappropriate breasts for the right hip circumference; 3.Feeling shy when wearing a swimsuit or tank top; 4.Smaller breasts and loss of elasticity after childbirth; 5.Change in the size and shape of the breasts after weight loss; 6.Significantly smaller breasts on one side than the other; 7.Wish to have a pair of full and firm breasts but do not want surgery; 8.Patients with partial/complete breast removal due to breast tumor and wish to have breast reconstruction. 8.Patients who wish to have breast reconstruction after partial/complete mastectomy due to breast tumor. Preoperative preparation: Good preoperative planning is the key to successful surgery, and the goodness of preoperative planning depends on the adequacy of information, so preoperative examination is essential. Pre-operative examination: Routine examination for surgical anesthesia (routine blood, chest X-ray, hepatitis, syphilis, HIV, liver and kidney function, electrocardiogram, etc.). Pre-operative breast examinations (breast palpation, mammogram, 3D breast MRI, etc.) are performed to rule out existing breast diseases and to understand the volume of the breast itself to determine the amount of fat that can be injected (the amount of fat that can be injected varies from 40% to 50% of the volume of the breast tissue itself, depending on individual conditions. After the Brava wearing period, MRI scans will be performed again to see if the patient’s breasts have expanded enough after wearing Brava and to determine if surgery can be performed. If the patient is too slim and has little body fat, it will make the surgery difficult and the postoperative result will be poor. Pre-operative Brava application: Patients should wear Brava for 3-4 weeks, 8-10 hours a day, 36-48 hours before surgery, until the surgery before anesthesia. Brava is available in a tight-fitting garment, so patients can wear it outside without affecting their appearance (see picture) Anesthesia: Combination of basic anesthesia and local anesthesia. Basic anesthesia is not used for tracheal intubation, and the patient’s discomfort is less after the surgery, which is commonly referred to as medium anesthesia plus minor anesthesia together without major anesthesia. Procedure: Generally, for breast augmentation candidates with autologous fat, the application of Brava’s autologous fat breast augmentation can achieve the expected results in 1-2 surgeries, but depending on the patient’s requirements and individual differences, another surgery may be required for injection. For post-operative breast reconstruction patients with breast tumors, 3-4 procedures may be required, and if the patient has received post-operative radiation, the number of procedures will be increased accordingly to the patient’s own condition. The duration of surgery is approximately 3-4 hours. Post-operative care:In general, Brava will continue to be worn for 3-4 days post-operatively for 4-5 hours per day in order to continue to assist with the autologous fat injection results. Patients can be discharged home 2-3 days after surgery and return to their normal work and life in about a week, with a follow-up appointment 1-2 weeks after surgery. Since Brava assisted autologous fat breast augmentation is less invasive, the post-operative pain is much less than traditional breast augmentation, and is mostly within the acceptable range according to patient feedback. Post-mammary tumor patients: For post-mammary tumor breast reconstruction patients, the effect of autologous fat breast reconstruction depends on the underlying conditions of the patient’s mastectomy site, and generally requires multiple surgeries, the worse the underlying conditions, the more surgeries are required. If the scar is small, the hyperplasia is not serious and the amount of soft tissue remaining is relatively good, while the results of those who have been treated with local radiation, have serious scars and less soft tissue are relatively poor. It is well known that any tumor has the risk of recurrence after surgery. Although there is no direct correlation between autologous fat injection breast augmentation and breast cancer recurrence, in order to prevent recurrence, patients should have regular postoperative checkups even if they do not undergo autologous fat breast reconstruction.