[decehek778]

Damaging tissue does not promote growth, it hinders it. Tissue expansion is a delicate thing. Adipogenesis is much greater when in a calorie surplus. Get a pressure gauge and don't over do it (-25mmhg is best). Growth is a slow thing don't over do it. Use topical oils high in triolein before and after to reduce skin irritation and inflammation. Your body is going to store fat where it wants to, this will only help guide it (slightly). Personally, I cannot see guiding regional fat storage more than a few percent. A few percent is more than no percent. I would guess the longer a routine is maintained the longer you can add a few percent. There is no study that shows the drop off point... though I would expect it to stop at some point.

https://journals.lww.com/plasreconsurg/a...me.24.aspx

Stretch is known to stimulate proliferation, whereas edema and inflammation are both emerging proadipogenic factors. Their combination in external volume expansion seems to produce proadipogenic effects, seen even after a single 2-hour stimulation.

https://journals.lww.com/plasreconsurg/f...in.55.aspx

Similarly, our group’s preclinical data have revealed that adaptation of expansion patterns with either shorter sessions, different interfaces, or variable cycles could yield outcomes with equivalent or even superior tissue expansion and vascular enrichment effect.7,8 These data suggest that lengthy sessions of external volume expansion may not be critical to achieve the desired effect, and instead may be detrimental to the surrounding skin. Improvements by abbreviated clinical protocols may translate to not only less surrounding tissue damage but also improved patient compliance with expansion. We look forward to more clinical studies exploring this topic as we continue to learn the best way to use this technique for our patients.

triolein is very high in a lot of cooking oils - Sunflower (high oleic variety) to name one. It is safe and non toxic to your skin. Here is an evaluation of it.
https://www.ewg.org/skindeep/ingredients...%20harmful

[Charley Rose]

Well this would turn a lot of thinking about pumping on its head, as most people who have got results from pumping have done so by doing it for very extended times. That's usually what people are encouraged to do.

[decehek778]

Well this would turn a lot of thinking about pumping on its head, as most people who have got results from pumping have done so by doing it for very extended times. That's usually what people are encouraged to do.

I would imagine so. With people getting results in a less than ideal environment, we could guess that there is potential gains left to be had. I wonder if these people pumping for these lengthy times are pumping any higher than -25mmhg. If they are under that pressure, I could see why they are still getting growth.

[Lotus]

The pump and release method (or short interval) has been around for a long time, I haven't read anything controversial about it. In fact I adopted the method over 10 yrs ago. I believe I gained about a cup and a half… I don't pump anymore, I reached my goals (D-cup) in less than two years using NBE, and pumping . A recent 3D mammogram showed my breasts are perfectly healthy. I have roughly 75% heterogeneous breast tissue… meaning i have dense breast tissue. Currently i'm a K-cup. Unfortunately, I was diagnosed with cancer (Leukemia, PH+ chronic myeloid Leukemia… which is a blood cancer that starts in your bone marrow last year). In my case I have a genetic mutation that was discovered last year, in all likelihood I've had Leukemia for a long time but went undetected. My CML has nothing to do with NBE/HRT, confirmed by several doctors (e.g. oncologists, cardiologists, surgeons, primary care provider). Apologies, tmi.
https://www.breastnexum.com/showthread.php?tid=17436&page=479

Imo, the more you pump for extended time periods (e.g. years) you'll develop saggy breasts. 
I don't recommend using sunflower oil, it's pro-inflammatory. 

Sunflower oil used in high amounts can be pro-inflammatory. Similarly, this can be true when anyone consumes too much omega 6 fatty acids in their diet. Omega 6 needs to balance with omega 3’s. A safe ratio is said to be 1:1, in my own opinion it should be 1:3 (omega 6 to omega 3). Now here's a controversial topic, meaning the controversy over omega 6 consumption to omega 3 (as discussed in this article). 
https://www.nutritionadvance.com/omega-6...a-3-ratio/
 
The research I looked at to prove pumping can be used more than 1-2 times (no more than 15 minutes) is as follows: 

Brava and autologous fat grafting for breast reconstruction after cancer surgery
Hirokazu Uda et al. Plast Reconstr Surg. 2014 Feb.

Abstract
Background: Although autologous fat grafting is widely accepted for breast reconstruction, its indications remain limited to minor contour deformities after reconstruction and small deformities after breast-conserving surgery. The authors describe a case series of total or nearly total breast reconstructions treated with the perioperative use of a vacuum-based external tissue expander (i.e., the Brava device) followed by autologous fat grafting.

Methods: The authors assessed the clinical outcomes and aesthetic results in six non irradiated total mastectomy cases and eight severely deformed irradiated breast-conserving surgery cases. Total Brava wearing time and skin complications were also investigated.

Results: The number of fat grafting procedures required ranged from one to four, and the mean amount of fat grafted during each procedure was 256 cc (range, 150 to 400 cc). Postoperative fat lysis and cellulitis occurred in two cases (14.3 percent). Brava worked effectively for total mastectomy cases, and improvement in the total aesthetic score was significantly higher than that in the breast-conserving surgery cases. All patients wore the device for more than 8 hours/day. The most frequent skin complication was dermatitis [n = 11 (79 percent)], which occurred in all breast-conserving surgery cases.

Conclusions: Brava was well tolerated by patients. Fat grafting with perioperative use of Brava is an alternative to total breast reconstruction in total mastectomy cases. However, for severely deformed breast-conserving surgery breasts treated with radiation therapy, the contracted skin was difficult to extend despite Brava use, and the results were less satisfactory. These cases also experienced a higher incidence of skin complications compared with the total mastectomy cases.
https://pubmed.ncbi.nlm.nih.gov/24150122/

The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes

13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeons.

However, although Uda et al.19 discouraged the use of Brava on irradiated tissue for the above-mentioned reasons, Kosowski et al.21 endorsed its use postulating that fat grafting to the irradiated breast could reverse radiation damage to yield superior results.40 Yet, also Kosowski et al.21 outlined that radiated breast tissue is less compliant, with consequent overgrafting and its inherent complications more likely to occur, recommending a greater craftsmanship and experience for a safe and effective execution of the procedure, and performance of multiple treatments (> 4) with small volumes of fat grafting.21

7 authors performed megavolume fat transplant (≥ 300 cc),2,7,11,13–15,17 and almost all the patients (1,272 over 1,274) received an average of more than 200 cc of fat graft per session.

However, after the enthusiasm generated by this first investigations, following researches outlined the limitations of the procedure: only small breast-size enlargement (1 cup) possible, high patient compliance required, patient social life restriction and dropout rates around 25%, 50% of the volume increase only due to swelling at 10 weeks with the suggestion to wear the device for 16–20 weeks.12,22,35–38

And finally:
In 1 article from our group, it was used a smaller device called Kiwi VAC-6000M with a PalmPump (Clinical Innovations, South Murray, Utah), a complete vacuum delivery system, which applies a stronger cycling negative pressure (-550 mm Hg) for a much shorter intraoperative period (10 times for 30 seconds each) on localized scarred recipient sites before autologous fat injection.24

Postoperatively, the Kiwi VAC was applied 3 times per day for 1 minute each for 3 days. The authors reported a gross expansion of tissue, with a macroscopic swelling that regressed slowly after the end of the stimulation, and a small degree of edema, which resolved without sequelae as complication. They also observed satisfactory clinical outcomes, with minimal morbidity and high patient acceptance and compliance.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865941/

[decehek778]

I don't recommend using sunflower oil, it's pro-inflammatory. 

Sunflower oil used in high amounts can be pro-inflammatory. Similarly, this can be true when anyone consumes too much omega 6 fatty acids in their diet. Omega 6 needs to balance with omega 3’s. A safe ratio is said to be 1:1, in my own opinion it should be 1:3 (omega 6 to omega 3). Now here's a controversial topic, meaning the controversy over omega 6 consumption to omega 3 (as discussed in this article). 
https://www.nutritionadvance.com/omega-6...a-3-ratio/
 
The research I looked at to prove pumping can be used more than 1-2 times (no more than 15 minutes) is as follows: 

Brava and autologous fat grafting for breast reconstruction after cancer surgery
Hirokazu Uda et al. Plast Reconstr Surg. 2014 Feb.

Abstract
Background: Although autologous fat grafting is widely accepted for breast reconstruction, its indications remain limited to minor contour deformities after reconstruction and small deformities after breast-conserving surgery. The authors describe a case series of total or nearly total breast reconstructions treated with the perioperative use of a vacuum-based external tissue expander (i.e., the Brava device) followed by autologous fat grafting.

Methods: The authors assessed the clinical outcomes and aesthetic results in six non irradiated total mastectomy cases and eight severely deformed irradiated breast-conserving surgery cases. Total Brava wearing time and skin complications were also investigated.

Results: The number of fat grafting procedures required ranged from one to four, and the mean amount of fat grafted during each procedure was 256 cc (range, 150 to 400 cc). Postoperative fat lysis and cellulitis occurred in two cases (14.3 percent). Brava worked effectively for total mastectomy cases, and improvement in the total aesthetic score was significantly higher than that in the breast-conserving surgery cases. All patients wore the device for more than 8 hours/day. The most frequent skin complication was dermatitis [n = 11 (79 percent)], which occurred in all breast-conserving surgery cases.

Conclusions: Brava was well tolerated by patients. Fat grafting with perioperative use of Brava is an alternative to total breast reconstruction in total mastectomy cases. However, for severely deformed breast-conserving surgery breasts treated with radiation therapy, the contracted skin was difficult to extend despite Brava use, and the results were less satisfactory. These cases also experienced a higher incidence of skin complications compared with the total mastectomy cases.
https://pubmed.ncbi.nlm.nih.gov/24150122/

The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes

13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeons.

However, although Uda et al.19 discouraged the use of Brava on irradiated tissue for the above-mentioned reasons, Kosowski et al.21 endorsed its use postulating that fat grafting to the irradiated breast could reverse radiation damage to yield superior results.40 Yet, also Kosowski et al.21 outlined that radiated breast tissue is less compliant, with consequent overgrafting and its inherent complications more likely to occur, recommending a greater craftsmanship and experience for a safe and effective execution of the procedure, and performance of multiple treatments (> 4) with small volumes of fat grafting.21

7 authors performed megavolume fat transplant (≥ 300 cc),2,7,11,13–15,17 and almost all the patients (1,272 over 1,274) received an average of more than 200 cc of fat graft per session.

However, after the enthusiasm generated by this first investigations, following researches outlined the limitations of the procedure: only small breast-size enlargement (1 cup) possible, high patient compliance required, patient social life restriction and dropout rates around 25%, 50% of the volume increase only due to swelling at 10 weeks with the suggestion to wear the device for 16–20 weeks.12,22,35–38

To clarify the comment regarding sunflower oil. High Oleic sunflower oil is almost completely omega 9 fatty acids. Mainly triolein 70-90%, which linked in my post at the bottom has a skin safety assessment. High oleic sunflower oil is not inflammatory even in the slightlest bit. 

In response to your comment regarding brava, that system is designed around using a very low pressure. -20 mmhg in their case. This pressure is definitely proven to work. Albeit not the most efficient or comfortable use of one’s time lol. The controversy part is mainly a catch in the title but is also relatively true in that we do not need to do everything with 100% of our free time and an informed approach can yield results while also allowing time for other activities in life. As noted in the reply article. Generally, less intensive protocols have higher adherence.

[breast4success]

Neither of the studies you posted support your conclusion.

In fact, the first study (co-authored by Mr. Brava/Evebra himself Dr. Khouri  ) shows that daily vacuum expansion for hours at a time encourages fat growth (i.e., increases in the number of adipocytes) which has been his theory all along on how to increase fatty breast tissue through external vacuum expansion.

Considering he's the "father" of using external vacuum expansion from 10 - 18 hours a day over several months (up to a year) for breast enhancement/growth, it seems odd that you interpret that study negatively. Further, the Brava pump used 15-30 mmHg suction. Dr. Khouri also has patients use a Brava Turbo device with a much higher suction -up to 100 mmHg - but that is strictly for preparing the breast for fat transfer augmentation procedures. Patients use it daily for hours at a time (24 hours if tolerable) for about 3 weeks before the procedure and a week or two afterwards but at lower pressures then. 

I don't encourage anyone use pressures that high if they aren't preparing for fat transfer - and neither does he - since the purpose is not to grow permanent breast tissue but again to prepare the skin (by stretching it as much as possible) and vascular structures to accept and retain the fat transfer. 

The quote from the second study is specifically regarding irradiated breast tissue from cancer patients via radiation treatment - not the typical vacuum pump user. Obviously, their skin is more susceptible to damage and complications if vacuum expansion is performed for too long (past the positive therapeutic effects of the vacuum). However, the study itself says nothing about what pressure to use and how long is "too long." Again, this is for fat transfer purposes. There are several posts from breast cancer patients on cancer forums describing their use of Brava for breast reconstruction. I suggest you read their first hand accounts rather than trying to gleam info from limited studies performed on mice.

The assertion that vacuum expansion should be performed for "no more than 15 minutes 1-2 per week" is just an opinion and not supported by any study.

[Karren H]

In my little engineer mind, it's all about exposure hours.  And maybe there is an optimum pressure and time that give you the most growth per unit time but I am happy with my 36DD breasts (starting with an A-B).  Even though I typically pumped at up to 5 psi (258 mm hg) and up to 3 to 4 hours per session, 6 to 7 days a week, for extended periods.

[SweetO]

So, my question is: high pressure or low pressure???

Also, what do we mean by high pressure? Cause I can definitely say TOO much pressure you get purple and you may end up with red dots!

[Karren H]

The first link says they used -25 mm hg which is less than half a psi. Hard to believe that domes will stay attached at that low pressure. Brava was considered a low pressure device at -80 mm hg which is about -1.5 psi.  I typically use -5 psi which I do not consider high and I have not done any visible damage to my breasts.  I have done -10 and you can do some damage at that pressure.   Think it’s more of an individual thing, some people have tougher skin and do not damage as easily.

[breast4success]

The first link says they used -25 mm hg which is less than half a psi.  Hard to believe that domes will stay attached at that low pressure.  Brava was considered a low pressure device at -80 mm hg which is about -1.5 psi.  I typically use -5 psi which I do not consider high and I have not done any visible damage to my breasts.  I have done -10 and you can do some damage at that pressure.   Think it’s more of an individual thing, some people have tougher skin and do not damage as easily.

The evebra is at 20 mmHg and the domes stay in place for hours as long as I don't lift up my arms past a certain point.

Again, the Brava pump only went up to 30 mmHg at the highest. The turbo pump was much higher but only fat transfer patients used and had access to that pump.

From Dr. Khouri's past responses anything 40 mmHG and up would be "high" - at least if you're trying to grow breast tissue with hours long sessions and not trying to prepare it for fat transfer.