The History of Fat Grafting to the Breast

Our illustrated timeline of “120 years of Fat Grafting to the Breast” will help debunk the myth that it’s a new procedure. It will guide you through all the advances of fat grafting to the breast as well as the important figures that have shaped it into the best alternative to breast reconstruction and augmentation.

1893 Gustav Neuber reports for the first time on fat grafting in the plastic surgery literature.
1985 Vincenz Czerny performs the first breast reconstruction by transferring a lipoma from the buttocks to the breast.
1910 Eugene Hollander publishes the first report of fat injection in the history of plastic surgery.
1919 Erich Lexer publishes Free Transplantations, a 2-volume textbook devoted to grafting with some clinical applications for fat graft breast augmentation and reconstruction.
1920 Alessandro Pennisi publishes Fat Grafts in Surgery, a book entirely devoted to fat grafting.
1950 Lyndon Peer conducts the first scientific studies on the biology of fat graft survival.
1962 Thomas M. Biggs is part of the team in Houston that performed the first breast augmentation with silicone implants.
1987 Mel Bircoll publishes his experience with breast augmentations using liposuctioned fat. Unfortunately his results are unimpressive and radiographic technology of the time is unable to differentiate with certainty calcifications of fat necrosis from cancer lesions. His publication is followed by an unprecedented position statement from the American Society of Plastic Surgeons banning fat grafting to the breast.
1999 Roger K. Khouri invents the BRAVA external breast expander device. Presentation of the scientific study by Dr. Thomas J Baker proving efficacy wins first prize at the American Society for Aesthetic Plastic Surgeons Annual Meeting.
2001 Sydney R. Coleman publishes Structural Fat Grafting, a monograph detailing his technique of fat grafting.
2001 BRAVA becomes available as a means of enlarging the healthy breast without surgery based upon the principle of sustained external tissue expansion.
2004 Roger K. Khouri realizes that the temporarily BRAVA-enlarged breast is an ideal recipient for the large volume of autologous fat grafts (AFT) needed to augment and reconstruct the breast. He obtains ethics committee approval and in collaboration with prominent plastic surgeons, he starts a large clinical study to prove the safety and efficacy of BRAVA and fat grafting for breast reconstruction and
2005 Scott Spear publishes his experience with fat grafting as an adjunct to other breast reconstruction methods and opens the door to its acceptance by the plastic surgery community in the United States.
2007 Gino Rigotti publishes the first report on the benefit of fat grafting for the treatment of radiation tissue damage.
2008 The American Society of Plastic Surgeons reverses its 20-year moratorium on fat grafting to the breast, realizing that if properly performed, the procedure is effective and poses no significant risk.
2009 Emmanuel Delay publishes Fat Injection to the Breast: Technique, Results, and Indications that is based upon his personal experience with 880 procedures over 10 years. This is the world’s largest and best -documented series at the time and shows that fat grafting the breast is safe and effective.
2009 Roger K. Khouri presents his study of breast augmentation with BRAVA and fat graft at the American Society of Plastic Surgeons Annual Meeting. Study reveals that the procedure is safe and effective.
2010 Roger K. Khouri’s presentation of Post Mastectomy Breast Reconstruction with BRAVA + AFT is awarded Best Scientific Report at the prestigious European Association of Plastic Surgeons. He subsequently presented this award-winning study at the American Association of Plastic Surgeons Annual Meeting.
2010 Gino Rigotti publishes an epidemiologic study based upon his 10 years of experience with 1000 patients showing that fat grafting has no effect on breast cancer recurrence. This confirms Emmanuel Delay’s findings.
2011 Numerous studies confirm the safety of grafting the breast with unprocessed liposuctioned fat. Major plastic surgery societies recognize that BRAVA + AFT is an accepted alternative method of breast reconstruction.
2012 Plastic and Reconstructive Surgery Journal publishes Roger K. Khouri’s 6-year, multicenter study. The results: pre-expansion with BRAVA prior to fat grafting is key to successful, single-stage large-volume breast augmentations.
2012 Roger K. Khouri and Gino Rigotti present their combined experience with immediate breast reconstruction with fat grafting at the American Association of Plastic Surgeons Annual Meeting.

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