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“In my research I learned there is not another procedure out there that is able to preserve sensation of the breast.”

Prophylactic Mastectomy with Immediate Reconstruction

With Dr. Khouri’s micro-fat grafting procedure, the patient could be back at work within 1-2 weeks, while a full recovery can be expected in 3 months. No morbidity, no complications, no foreign material and no new scars.

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 with fat prophylactic

Before Mastectomy

Fifty five year old woman with carcinoma of the right breast. She has markings for a right therapeutic mastectomy and a left prophylactic mastectomy. The nipples will to be spared as part of the bilateral mastectomy. Markings on the midsection and thighs indicate our liposuction plan to obtain the fat grafts while the oncologic surgeon performs the mastectomies. The fat grafts are then meticulously injected into the exposed chest muscles and the mastectomy wounds are closed.

prophylactic mastectomy reconstruction immediate with fat

After Mastectomy

One month after the bilateral nipple sparing mastectomy, she begins preparation for external expansion. The fat grafts avoided a sunken-in appearance in her breasts post mastectomy. Throughout the reconstruction process, she chose to wear a “social breast” with padding.

immediate mastectomy reconstruction with BRAVA prophylactic

1st BRAVA Expansion

In preparation for the first fat transfer reconstruction procedure, she completed external expansion. At the follow up visit, 10 weeks post mastectomy, she is ready to undergo her first fat grafting session. BRAVA has generated a visible breast mound that is ready to receive fat transfers. The swelling would have rapidly subsided if she stopped BRAVA and did not receive fat grafts. However, by grafting this BRAVA generated scaffold with her own fat we are tissue engineering her new breasts.

prophylactic mastectomy reconstruction immediate with fat

Preparing for 2nd Fat Grafting Session

Five months after the mastectomy, the BRAVA and fat grafts have begun to regenerate her breasts with tissue engineering. The markings identify the areas where fat will be grafted for the second fat transfer session. These markings also indicate the RAFT technique that will improve breast contour, define the breast fold and create an additional recipient matrix to provide more volume.

immediate mastectomy reconstruction with fat prophylactic after 2nd surgery

After 2nd Fat Grafting Session

Seven months after the second fat grafting session, she has regenerated her natural breasts. Her breasts are larger, soft and sensate, much like her natural breasts. She is very satisfied with her breast reconstruction. Some women may choose to undergo an additional session of BRAVA and fat grafts to achieve a larger augmentation.

prophylactic mastectomy reconstruction after second surgery with fat

A Year After Mastectomy with Immediate Reconstruction

At the follow up visit, she has restored natural and sensate breasts. The two liposuction sessions have also improved her overall body figure by getting rid of unwanted fat deposits.

Prophylactic Mastectomy

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.

Using BRAVA for Immediate Reconstruction

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:

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

Fat Transfer During Immediate Reconstruction

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.

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Miami Breast Center | 580 Crandon Blvd, Suite 102, Key Biscayne, FL 33149