Tissue-engineered breast reconstruction with Brava-assisted fat grafting: a 7-year, 488-patient, multicenter experience.

BACKGROUND: The ability of autologous fat transfer to reconstruct an entire breast is not established. The authors harnessed the regenerative capabilities of external expansion and autologous fat transfer to completely reconstruct breasts. METHODS: The authors performed 1877 Brava plus autologous fat transfer procedures on 616 breasts in 488 women to reconstruct 99 lumpectomies, 87 immediate breast reconstructions, and 430 delayed total breast reconstructions. After 2 to 4 weeks of Brava expansion, which increased volume by 100 to 300 percent, the authors diffusely grafted the breasts with 100 to 400 ml (225 ml average) of 15 g-sedimented, manually harvested lipoaspirate. The procedure was repeated every 8 to 14 weeks until completion. The authors compared costs of this reconstruction with established deep inferior epigastric artery perforator/transverse rectus abdominis musculocutaneous flaps and implant procedures. RESULTS: Follow-up ranged from 6 months to 7 years (mean, 2.5 years), with 0.5 percent locoregional recurrence. Four hundred twenty-seven women completed the reconstruction, whereas 12.5 percent dropped out (2.5 percent medical, 10 percent personal reasons). Completion required 2.7 procedures for nonirradiated and 4.8 procedures for irradiated mastectomies. Patients recovered soft, natural appearing breasts with nearly normal sensation. Complications included five pneumothoraces and 20 ulcerative infections. Radiographically recognized benign palpable masses were observed in 12 percent of nonirradiated and 37 percent of irradiated breasts. The cost of Brava plus autologous fat transfer is 47 percent and 66 percent that of current reconstruction alternatives. CONCLUSION: Brava plus autologous fat transfer is a minimally invasive, incisionless, safe, economic, and effective alternative for breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study.

BACKGROUND: Breast augmentation by autologous fat transfer is an appealing alternative in need of scientific validation. METHODS: In a prospective multicenter study, 81 women (age range, 17 to 63 years) wore the Brava device, a bra-like vacuum-based external tissue expander, for 4 weeks and then underwent autologous fat injection using 10 to 14 needle puncture sites into each breast in a three-dimensional fanning pattern (average, 277 ml volume injected per breast). Patients resumed Brava wear within 24 hours for 7 or more days. Pretreatment and posttreatment breast volumes were derived from three-dimensional volumetric reconstruction of magnetic resonance imaging scans, and outcomes were compared with a meta-analysis of six recent published reports on autologous fat transfer breast augmentation without expansion. Follow-up ranged from 12 months to 6 years (average, 3.7 years). RESULTS: Breast volume was unchanged between 3 and 6 months. Seventy-one of the treated women were compliant with Brava wear and had a mean augmentation volume at 12 months of 233 ml per breast compared with 134 ml per breast in published series without Brava (p < 0.00001). Graft survival was 82 ± 18 percent compared with 55 ± 18 percent without Brava (p < 0.00001). There was a strong linear correlation (R = 0.87) between pregrafting Brava expansion and the resultant breast augmentation. There were no suspicious breast masses or nodules. Magnetic resonance imaging recognized a 16 percent incidence of fat necrosis easily identified at 1-year mammographic evaluation. CONCLUSION: : The addition of Brava expansion before autologous fat grafting leads to significantly larger breast augmentations, with more fat graft placement, higher graft survival rates, and minimal graft necrosis or complications, demonstrating high safety and efficacy for the procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Orientation tuning in the visual cortex of 3-month-old human infants.

Sensitivity to orientation is critical for making a whole and complete picture of the world. We measured the orientation tuning of mechanisms in the visual cortex of typically developing 3-month-olds and adults using a nonlinear analysis of the two-input steady-state Visually Evoked Potential (VEP). Two gratings, one a fixed test and the other a variable orientation masker were tagged with distinct temporal frequencies and the corresponding evoked responses were measured at the harmonics of the test and masker frequencies and at a frequency equal to the sum of the two stimulus frequencies. The magnitude of the sum frequency component depended strongly on the relative orientation of the test and masker in both infants and adults. The VEP tuning bandwidths of the 3-month-olds measured at the sum frequency were similar to those of adults, suggesting that behavioral immaturities in functions such as orientation discrimination and contour integration may result from other immaturities in long-range lateral projections or feedback mechanisms.

Contour integration by 6-month-old infants: discrimination of distinct contour shapes.

Previous research has indicated that the ability to integrate individual elements in the presence of noise is immature in 3-month-old infants. The present study extended the developmental timeline by investigating 6-month-olds' ability to integrate individual elements into whole contours through an assessment of their capability to discriminate circle and square contours constructed from oriented Gabor patches via a newly designed cueing paradigm for infants. If infants discriminate the centrally-presented contour cues, then their eye movements would correctly anticipate subsequent target presentation at a rate greater than chance. The results indicated that infants integrated the contours and discriminated the different shapes, but, consistent with past research, this ability is still fairly immature at this age, tolerating limited amount of noise.

Internally generated memory testing: results of repeated test administration.

A critical memory skill rarely clinically tested is the ability to remember self-generated material. Healthy aged participants (n = 30; Experiment 1) and pilot participants with probable Alzheimer disease (pAD) (n = 9; Experiment 2) were twice administered a memory test including both internally generated and externally supplied items for recall. Healthy aged participants were biased to recall internally originating over externally supplied material on first, but not second, presentation. However, pAD participants demonstrated internal bias during both sessions. The pAD participants were also specifically impaired when told to remember internal material. This study provides further evidence that internally originating items can be used to assess memory. In pAD, memory for internal material with specific attempt to remember may be selectively impaired.

Stability in young infants' discrimination of optic flow.

Although considerable progress has been made in understanding how adults perceive their direction of self-motion, or heading, from optic flow, little is known about how these perceptual processes develop in infants. In 3 experiments, the authors explored how well 3- to 6-month-old infants could discriminate between optic flow patterns that simulated changes in heading direction. The results suggest that (a) prior to the onset of locomotion, the majority of infants discriminate between optic flow displays that simulate only large (> 22 deg.) changes in heading, (b) there is minimal development in sensitivity between 3 and 6 months, and (c) optic flow alone is sufficient for infants to discriminate heading. These data suggest that spatial abilities associated with the dorsal visual stream undergo prolonged postnatal development and may depend on locomotor experience.