The BRAVA system was initially developed by Dr Roger Khouri of Miami around the end of the 90s, as a means of enhancing the volume of the breasts. It consists in a pair of semi-rigid domes with a little silicone cushion at the base, serving as interface to the skin. The domes are connected to a battery pump that enables them to create a more negative pressure than that of the environment, virtually applying a suction force on the breasts, thus enhancing their volume temporarily.
The idea of using Brava as a means to prepare fat autografts has occurred to the same Roger Khouri, who had become acquainted with our lipomodelling procedures at a congress and who immediately understood the potential of this action: the interest of creating oedema thanks to the distension expansion technique of the Brava, which he could than use to inject larger quantities of fat in the expanded breast. In order to be efficient, the system has to be worn 10 to 12 hours daily, 4 weeks prior to the lipomodelling session.
The use of Brava can be of interest in cases of severe hypotrophy or difficult reconstructions, especially those in which the patient lacks receiving tissues. In certain particular cases (to be evaluated in consult), Brava allows injecting a larger volume of fat per session of fat transfer.
The limits of this technique are related to the constrictive and uncomfortable character of the device, which means that it can generally be applied only to very motivated patients, who are willing to wear it one month before the surgery, as well as on month following it, for 10-12 hours a day. Another limiting factor is represented by the fact that the device is costly (around 1500 euro), non reimbursed by the Health Insurances, and therefore prohibitory for cases of reconstructive surgery.