Dr. Khouri says that, "80% of his practice is comprised of removing traditional implants from women who are not satisfied with the results or are experiencing physical problems." Dr. Khouri invented the BravaTM device in the 1990s following his realization that if a surgeon expands tissue, it grows. In order for tissue to grow, it requires sustained stretch. In addition, in the mid 90's the FDA recalled silicone implants. Brava is a device worn like a bra with a vacuum pump that pulls on the tissue to stretch it. The device is typically worn at night and is painless. The vacuum pump is in a small pocket of the bra. To prepare the breasts for fat grafting, the BravaTM is typically worn for 2-3 weeks. Some women use the BravaTM as a "Cinderella" enhancing device, but this is only for women who have "their own" breasts and are unhappy due to child birth or small cup size.
In order for Dr. Khouri to have a patient's own fat for grafting into the breast, it is taken via liposuction where they have excess to spare. It could be as much as two pounds of fat from an area such as the abdomen buttocks, thighs knees or wherever there is excess. A woman also benefits from having fat taken from where she does not want it and using it where it is needed, i.e. the breasts.
Breast Augmentation/Reconstruction Benefits with BravaTM
BravaTM and fat grating gives women natural breasts, with no scar, no incision plus the benefit of liposuction. The fat grafting is permanent whereas implants have a limited life span. It is also easier for mammograms to be read because implants can obscure the breasts. For mastectomy patients, women will have nipples with normal sensation which is not typically accomplished with traditional implants. For those women who wish to have large breasts, it is possible for Dr. Khouri to create double D's using this technique. If a patient wants a larger or smaller cup size following the procedure, this can be accomplished by suctioning fat or adding fat. In a sense, this makes for an adjustable implant without the need for removal as with saline or silicone.
For post mastectomy patients who have already spent thousands on medical bills, the best news is that the liposuction and fat grafting are covered by insurance. The BravaTM device is not covered and costs about $1,000. This is a seemingly small price to pay for natural looking reconstructed breasts with no scars, incisions and normal nipple sensation.
Roger K. Khouri, MD, FACS: Biography
Roger K. Khouri, MD, FACS is a board certified plastic surgeon trained in general surgery at the University of North Carolina, in plastic surgery at Brown University, in reconstructive microsurgery at New York University, and in hand surgery at Harvard. Dr. Khouri is a scholar in plastic surgery with over 100 peer-reviewed scientific publications. He was Professor of Plastic Surgery at Washington University School of Medicine before moving to Miami. Dr. Khouri is married to Dr. Susana Leal-Khouri a renowned pathologist and dermatologist and they have five children.
Dr. Khouri is the founder of the Miami Breast Center. He has more than 25 years of experience as a reconstructive surgeon. In 2002 He was awarded the prestigious Godina Lectureship in Microsurgery. He was a pioneer in reconstructive microsurgery and flaps before becoming a pioneer in fat transfer to the breast. In 1999 he invented the BRAVA external expander which led him to develop the breakthrough third-option breast reconstruction procedure called BRAVA + AFT (Autologous Fat Transfer).
In 1997 Dr. Khouri published in the Annals of Surgery, the most prestigious scientific surgery journal, what was then the largest experience in the world with breast reconstruction using microsurgery (DIEP) and TRAM flaps. Over the past decade, always on the lookout for something better, he perfected BRAVA + AFT, a far better and much more patient-friendly alternative method of breast reconstruction. Along the way, he has contributed to many innovations in liposuction and lipografting, and he became a recognized innovator and expert in natural, no implant, breast augmentation and post-mastectomy breast reconstruction.
For his expertise and his pioneering work on the regenerative abilities of fat grafts and BRAVA in breast reconstruction and augmentation, Dr. Khouri has been invited to lecture all over the world. He has taught at more than 200 national and international plastic surgery society meetings in more than 35 countries. For his contribution to breast reconstruction with BRAVA + AFT, he won the award of Best Scientific Work at the prestigious European Association of Plastic Surgeons (EURAPS) and the American Association of Plastic Surgeons in 2010. He was also just awarded the best scientific paper of 2012 in the Plastic and Reconstructive Surgery Journal.
In Miami, Dr. Khouri has personally trained more than 500 surgeons from 40 countries on his breakthrough procedures. He instructs by performing live-surgery demonstrations and one-on-one examinations with his patients. Many of the surgeons who took his course (www.fatgraftcourse.com)
A founding member and the vice president of the International Society of Plastic and Regenerative Surgeons (www.ISPRES.org), he is a firm believer and a major force behind the evolution of plastic surgery from the scalpel-intensive reconstructive operations toward the minimally-invasive regenerative procedures.
Roger K. Khouri, MD, FACS operates with his team at the Key Biscayne Surgery Center as well as at most of the hospitals in Miami.
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