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Controlled trials have shown that an external breast tissue expander (Brava; Brava LLC Miami, Fla.) can effectively enlarge the breast without surgery. However, satisfaction with the results has varied among doctors and patients. The first author critically evaluated her clinical experience with Brava and attempted to identify factors associated with a successful outcome.Between May of 2003 and September of 2005, the first author supervised the treatment of 50 women. Volume measurements and standardized photographs of the breasts were obtained at the beginning of treatment and up to 12 months after treatment ended. At the final visit, women completed a satisfaction questionnaire.Forty women were evaluated at an average of 10 months after discontinuation of treatment (range, 7 to 20 months). Reasons for drop-out were noncompliance with the treatment (n = 6), unwillingness to attend follow-up visits (n = 3), and more than 5 percent body weight change (n = 1). The women used Brava 11 hours a day for a median period of 18.5 weeks (range, 14 to 52 weeks). The median volume increase was 155 cc (range, 95 to 300 cc). Thirty women (75 percent) were satisfied or very satisfied with the results, five (12.5 percent) acknowledged enlargement of their breasts but considered the treatment too bothersome, and five (12.5 percent) were disappointed because of little growth. Factors associated with poor growth included lesser intensity of wear (p < 0.002) and low body mass index (p = 0.055).Long-term breast enlargement without surgery is possible with an external tissue expander. The more it is used, the more the breasts grow. To avoid disappointments and drop-outs, women have to be well informed about the time and lifestyle commitment.