Breast augmentation

Patient Information sheet

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Natural Breast Augmentation with Fat Transfer

If you are looking for a natural breast augmentation, we can help you. Micro-fat grafting is an implant-free fat transfer breast augmentation technique developed by the highly respected and much published Dr. Roger Khouri, plastic surgeon at the Miami Breast Centre. David Crabb (plastic surgeon) has trained with Dr Khouri and is the only surgeon in New Zealand trained in this procedure. The procedure is simpler than many conventional procedures and, although technically complex, is less stressful on your body than traditional methods, and recovery time is quick. Patients go home on the day of surgery.
There is a lot less pain than with implants (particularly those that need to go under the muscle).

One of the many advantages is that no prosthesis is used

Your surgeon, David Crabb, has been in practice long enough to see all the problems that implants create, many requiring removal because of rupture or because they simply wear out. He is delighted to have a non-implant method that uses your own tissue and would prefer it if he didn’t have to use implants again.
David Crabb has worked in the public system reconstructing breasts for sometime and is very experienced in most forms of breast surgery.
He has considerable experience in medium volume fat grafting without the use of the BRAVA external expansion (which allows larger volumes to be injected).
The Khouri method means much larger volumes of fat can be injected into your breasts. This means you can usually achieve the desired results in one or two procedures.

BRAVA device is not usually necessary

For many, the loss of breast substance after babies means only one procedure may be necessary as the skin envelope is looser and more accommodating and the use of the external suction BRAVA device is not required. However, for smaller-chested, younger women it is likely that two procedures would be required to sufficiently grow the skin envelope, unless only a one cup size increase is wanted. The BRAVA device is only used in cases where additional skin laxity needs to be generated.
Most importantly, the final result is part of you – no implants, no ruptures, no use by dates and no medical scars. Instead, you will have soft, natural breasts and no implants to worry about.

Your first appointment with David Crabb

For out of town patients, a complimentary Skype consultation is available to see if the procedure is right for you. In more complex cases, additional consultation may be required.

A careful family history is taken with respect to breast cancer, and an MRI may be arranged to establish baseline imagery. After your breasts are naturally enhanced with your own fat cells, routine mammography is all
that is required for screening (as fat is completely radiolucent). Annual check up is advised and we can arrange this (or we can advise your usual GP/breast specialist about this).

The procedure

The technique is minimally invasive and has the side benefit of utilising liposuction to harvest the fat from areas of your body with unwanted fat, e.g. thighs, hips, medial knees and stomach. Buttocks are not usuall used as no one wants a flat bum!

There are no cuts, only little knicks where the fat is extracted or grafted, requiring single stitches.
The breasts are usually not particularly painful but the donor sites can be sore for a day or two.

We recommend a support garment such as Spanx or occasionally custom measured garments.

For cases where we know in advance that two rounds of grafting will be required, we may harvest from only one side to make the post-op period more comfortable.


The use of the BRAVA is indicated where we need to generate more skin laxity. It is more commonly used for breast reconstruction after cancer and particularly where scarring is present.

For a few weeks prior to the procedure, if required, you will need to wear an external expander called BRAVA. This soft gel-like brassière gently suctions the breast area in order to create an adequate matrix
for the fat injections.
At first, the breast is conditioned with a low suction sports pack which is battery powered and fits into the palm of your hand. After a few days, you switch to use a squeezy bulb manual vacuum pump which
is like a blood pressure bulb. Finally, in the last two weeks, you are switched to a motorized pump which you carry in a shoulder bag.
You adjust the pressure, starting at a comfortable level and gradually increasing it, depending on your tolerance. Most patients ramp it up in the week prior to surgery to achieve the maximum expansion so we
can maximize the amount of grafted fat in your new breast.
Ideally, just prior to surgery, we want the BRAVA bra to have made your breast size about one third more than the desired final size.
The BRAVA is worn for two weeks after surgery and then discontinued.
If a second step is needed the BRAVA can be used again.

Creating the vascularized scaffold

External expansion of the breast occurs via slight but consistent vacuum pressure created by Brava. Brava expands and generates growth of new tissue and blood vessels. This expansion allows room
for mega volume micro-fat grafts.

Fat grafting

Your fat is harvested from several areas of your body through liposuction and strategically injected into your breasts. No cuts or Incisions are made. New blood vessels form around the new fat
deposits allowing for fat integration and a high ratio of fat survival.

Patient Case

Fat transfer process

David Crabb removes fat from one area of your body and meticulously injects it back as hundreds of tiny individual droplets in the breast site.
These micro-fat transfers are harvested by gentle liposuction from the thighs, buttocks and stomach – wherever there is fat to spare. Even slender patients do well with this procedure as we usually find enough
fat cells. The fat then “takes” like a graft with gradual replacement by cells that grow in.
Fat cell survival is between 50% and 95% with an average of two thirds survival. The use of the Brava is very helpful as it increases blood supply and lymph flow which sustains the grafts.
Using your own fat, we will fulfill your desire of having larger breasts. New mothers also love our procedure, since it is perfect to restore volume that normally dissipates after child birth. As compared to
implants and natural breast enhancement techniques (such as herbal remedies, creams, foods and exercise), breast augmentation with fat transfer involves no incisions, no new scars and no foreign objects.
You will love your new breasts.


The procedure is done as an outpatient (no overnight stay required), under general anaesthesia and sedation.


Average recovery time is 2-4 days, a lot quicker than with implant surgery.
The benefits of our procedure include:

  1. No foreign object in body
  2. Quick recovery
  3. No cuts, no incisions
  4. Liposuction
  5. No implant problems
  6. Minimally invasive

Am I a candidate?

Most women are candidates for our Brava and fat transfer breast regeneration procedure. There are only four disqualifiers:
1. Smoking: Smokers have a poor capacity to regenerate tissue. We recommend that a patient stops smoking at least two months before the procedure
and abstain completely throughout the process, and for three months after. If she cannot comply, we cannot help her.
2. Herceptin® chemotherapy and other angiogenesis inhibitors: These prevent the revascularization of the fat graft and lead to a poor outcome. We recommend the process be started about one month
after a patient completes her course of Herceptin treatment.
3. Aspirin, over-the-counter food supplements and vitamins that may impair blood clotting: It is imperative that the patient stops aspirin, all vitamins, and all herbal supplements at least two weeks before the procedure.
4. Poor understanding of the procedure and inability to comply with the Brava expansion treatment: A GP referral letter with your history would be the preferred first contact. At your appointment, your history and medications will be reviewed with David Crabb, and your smoking status taken. Your breast or mastectomy site will be examined and photographed. A general discussion will ensue. Patients wishing to proceed will then
have a fitting for the Brava bra, together with instructions for its use – information sheets will be provided for future reference. An estimate of the costs will be provided at this time.
The cost of the first consultation is rebated in the operation cost.
A nurse contact number will be provided for ongoing support.

Where to from here?

Contact Northland Plastic Surgery or Rodney Surgical Centre to arrange an appointment or free Skype consultation with David Crabb.