Prophylactic Mastectomy Plus Reconstruction

With Dr. Khouri's micro-fat grafting procedure, the patient is usually up and back to her normal life within 3 days. No morbidity, no complications, no foreign material and no new scars.

Prophylactic Mastectomy

Prophylactic immediate reconstruction before and after photo

If you are at risk for hereditary breast cancer and have tested positive for the BRCA1 or BRCA2 Gene, we are here to ease your mind. Dr. Roger Khouri has pioneered a natural breast reconstruction, following a prophylactic mastectomy, that will help you reclaim your breasts. Our scientifically-proven third option procedure is the least invasive reconstruction method, producing the most natural results.

One of the major side benefits of our BRAVA + AFT procedure, is that unlike implant or flap reconstructions, we are able to restore the nerves, resulting in near-normal sensation in the breasts. No other procedure does this. Our friendly staff will walk you through the process, step by step, so you feel comfortable with your decision. Some of our staff members are breast cancer survivors so we understand the emotions you are dealing with at a time like this. Kindness and compassion go hand-in-hand with our breakthrough medical procedure.

Most women who have a prophylactic mastectomy chose to do immediately reconstruction. We are able to help you restore your breasts at the time of your surgery or at a later date. Our technique is explained in detail below. Please also visit the Prophylactic Breast Reconstruction Photo Gallery, page of the site.

Immediate Mastectomy Reconstruction Sequence

Immediate Mastectomy Reconstruction

Before Mastectomy
Forty-year-old woman with carcinoma of the left breast. She has markings for a left therapeutic mastectomy and a right prophylactic mastectomy. The nipples are to be removed as part of the mastectomy while we preserve the pigmented skin of the areola. Markings on the thighs indicate our liposuction plan to obtain the fat grafts while the oncologic surgeon performs the mastectomies. We will then meticulously inject the fat graft into the exposed chest muscles and close the mastectomy wounds.

Prophylactic Mastectomy Reconstruction

After Mastectomy
Three days after the mastectomy the patient has small breast mounds from the fat grafted into the pectoralis. The mastectomy drains will be removed in a few days.

Immediate Mastectomy Reconstruction

1st BRAVA Expansion
One month after the mastectomy, she starts BRAVA expansion for 4 weeks in preparation for the first post-mastectomy grafting session.

Prophylactic Mastectomy Reconstruction

Preparing for 2nd Fat Grafting Session
Two months after the mastectomy, BRAVA has generated a nice breast mound that is ready to receive additional fat grafts. This swelling would have rapidly subsided if she stopped BRAVA and did not receive the fat grafts. However, by grafting this BRAVA generated scaffold with her own fat we are tissue engineering her new breasts.

Immediate Mastectomy Reconstruction

After 2nd Fat Grafting Session
Six months after this grafting session she has regenerated B cup breasts.

Prophylactic Mastectomy Reconstruction

Achieved Previous Breast Size... But She Wants Larger
The breasts are soft, have essentially normal sensation, feel just like original ones, and perfectly fit into her original pre-mastectomy bras. However... she always wanted larger breasts, So we agreed to proceed with another session of BRAVA + AFT and enlarge them like we would perform a regular BRAVA + AFT breast augmentation.

Immediate Mastectomy Reconstruction

2nd BRAVA Expansion
She wears BRAVA again for 4 weeks to expand her B cup breasts in preparation for the second post-mastectomy fat graft. At this point she is treated like a woman with B cup breasts who desires BRAVA + AFT breast augmentation.

Prophylactic Mastectomy Reconstruction

Before 3rd Fat Grafting
Markings at the time of her second post-mastectomy fat graft session. Fat will be harvested from abdomen and grafted in the breast in addition to specifically targeting areas of tissue deficiency.

Immediate Mastectomy Reconstruction

1 Year After
Appearance 1 year later. She has regenerated new breasts that are larger than her original ones. The 3 liposuctions have also improved her overall figure by getting rid of unwanted fat deposits.


Ideally, the procedure begins in the operating room at the time of your prophylactic surgery. Dr. Khouri will join your oncological surgeon in the operating room. Right then and there, he will begin the reconstruction process by performing a gentle limited liposuction to harvest some of your own fat and then inject it into the breast area, so that you leave the hospital with a slight breast mound.

Note: For those patients who had a prophylactic mastectomy in the past, the procedure begins with the next step below.


The patient starts the reconstruction process by wearing the external expander device called BRAVA after her prophylactic mastectomy. She wears the bra while she sleeps for 3 to 5 weeks prior to the first grafting session. BRAVA is a comfortable soft gel-like bra. See BRAVA page for more details.

Not only does BRAVA expand the skin from the outside, it also has the effect of regenerating an edema like breast mound through the expansion of tissues and nerves. BRAVA also increases the blood flow to the mastectomy scar. This does two important things, which are unique to this technique:

  1. It creates an adequate vascular matrix into which the liposuctioned fat is later injected.
  2. It allows the patient to keep almost normal sensation in her breasts and nipples.

Fat Transfer

Once the patient has worn the BRAVA for a few weeks, she goes for an out-patient procedure where fat is removed from one area of her body and meticulously injected back as hundreds of tiny individual droplets at the breast site that has been enlarged by the BRAVA expansion. These micro-fat grafts are harvested by gentle liposuction from the patient's thighs, buttocks and stomach - wherever there is fat to spare.

There are no incisions, no new scars...only tiny needles and very quick recovery time. Body sculpting is a side-benefit that women love. Your new breasts will feel and look natural but they will contain no breast tissue.

We are currently able to achieve up to a small B cup natural breast filled with your own fat with only one small outpatient fat grafting procedure. To attain larger breast cup sizes, the fat grafting process usually has to be repeated 2-3 times over a period of 2 - 6 months.

For more information on this reconstruction please go to Reconstruction After Mastectomy page.

We are proud supporters of FORCE, the only national nonprofit organization devoted to hereditary breast and ovarian cancer. Their mission includes support, education, advocacy, awareness, and research specific to hereditary breast and ovarian cancer.

Dr. Khouri was a presenter at their conference last year and will be presenting his breakthrough BRAVA - AFT procedure again at this year's October 2012 conference. Please join us.