Dr. Khouri Explains the use of BRAVA in His Procedures

VIDEO TRANSCRIPTS

The key to our success is gentle micrografting handling of the fat. But more importantly, the most important factor is the BRAVA. That is the device that allows us to enlarge the breast, whether it's a mastectomy or a small breast. It enlarges that area, creates edema. It's a temporary enlargement; that's how we use it. You don't really create tissue. But you open up this field; open up the planes and allow us to put more fat. We can disperse many more droplets in an enlarged field than in a tiny spot. What we do; imagine: Our contribution here is the realization that you really need to have a larger field to get these seeds to survive.

If you want to put a lot of seeds, you need to have a large field. Trying to pack too many seeds in a small field won't work. So, BRAVA takes a small pot and stretches it out. It also fertilizes it, so now instead of that small pot, you have a much larger area and you can put many more seeds, separated, one at a time, in a fertilized field, and get the whole thing to survive. It's actually pretty simple. You can't put too much in a small pot. You make the pot larger, you fertilize it, then you can put a lot and predictably survive. Conventional tissue expanders (I call them "tissue compressors"), they compress the tissues. When that balloon is inflated, it compresses the skin. It compresses everything. It only stretches the envelope. But you really; it becomes like cardboard. It's a really bad thing for fat grafting.

You leave behind a dead space that you will replace with a foreign implant; an inert material. BRAVA expansion opens up everything. It stretches not only the skin envelope, but the entire matrix. We create a scaffold. We create a recipient structure that now we can seed with cells. Instead of compressing, we open up everything. So, it's a true tissue expander. BRAVA is a true tissue expander. The traditional ones are tissue compressors. They compress the tissue, stretch an envelope. BRAVA opens up the tissue, expands the tissues, allows us to put little fat grafts in that scaffold it generated. As you expand the tissue with BRAVA, you also expand blood vessels, but you also expand the nerves. So, the nerves grow with that tissue.

And when the nerves grow and you put the fat and the nerves have grown, the nipple at the ends that you build will have sensation. So, we regenerate the whole thing inside like it happened when you were a kid; a teenager growing up. The breast grows and the nerve grows with it. The whole thing grows and the nerve grows with it. But right now there's really only edema. It's not; the cells didn't grow really; we didn't create any cells. We have to add the cells by liposuction and it becomes a stable construct. It is a breakthrough. This is a breakthrough. We were not; conceptually we have to take a piece, plug it in there. Or, stretch an envelope and put in implants. Now, we're stretching the whole thing, putting fat in there, and that whole thing has sensation and it feels like the real thing. It's grown back inside, too.