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Browne DT, Monserrat J, Matas A, Sese B, Llull R. The Effect of Fat Grafting on Expansion Pressures in Expander-Based Postmastectomy Breast Reconstruction: Outcomes in Normal and Irradiated Tissues. Ann Plast Surg 2022; 88:S455-S460. [PMID: 35690939 DOI: 10.1097/sap.0000000000003156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The impact of fat grafting on the viscoelasticity of irradiated tissues is poorly defined. We investigate the effect of subcutaneous fat grafting on postmastectomy tissue expansion in patients undergoing delayed breast reconstruction. We quantify observed viscoelastic and trophic changes of the skin envelope. We hypothesize that fat grafting changes the trophic and viscoelastic properties of the breast soft tissue envelope. METHODS Postmastectomy defects delayed more than 2 years and reconstructed with subpectoral tissue expanders were prospectively studied. Control (no irradiation, no fat grafting, n = 7), fat grafted (no irradiation, fat grafting n = 8), and irradiated plus fat grafting (irradiation, fat grafting, n = 9) groups were included. Hydrostatic pressures of the tissue expanders were measured before and immediately after expansion, and again postexpansion day 1. Pressure changes calculated as "postexpansion-relaxation interval": difference between maximal pressure at each expansion and the minimal pressure before the next expansion session. Differences were analyzed between groups. RESULTS Hydrostatic pressure plots reflect the soft tissue ability to accommodate sequential expansion. Fat grafted breasts demonstrated a statistically significant increased postexpansion-relaxation interval versus the nongrafted control group (P < 0.0001). Irradiated plus fat grafting breasts achieve similar postexpansion relaxation interval to the control group (P = 0.597). These changes are observed at postoperative week 6. Viscoelastic changes impact the overall expansion time: the fat grafted group achieved total expansion 2 weeks earlier than the nongrafted control group (P = 0.019). The fat grafted, radiated group completed expansion in similar time interval as nongrafted control group. CONCLUSIONS Observed viscoelastic changes impact the overall expansion time. Fat grafting in nonradiated mastectomy defects allows for shorter expansion period. Fat grating in radiated postmastectomy defects allows expansion durations equivalent to nonradiated, nonfat grafted control defects. There is a delayed effect of fat grafting observed at postoperative week 6.
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Affiliation(s)
- Donald T Browne
- From the Department of Plastic and Reconstructive Surgery, Wake Forrest Baptist Health, Winston-Salem, NC
| | - Javier Monserrat
- Cancer Cell Biology Group, Institut d'Investigació Sanitària Illes Balears, (IdISBa), Palma de Mallorca, Spain
| | - Aina Matas
- Cancer Cell Biology Group, Institut d'Investigació Sanitària Illes Balears, (IdISBa), Palma de Mallorca, Spain
| | - Borja Sese
- Cancer Cell Biology Group, Institut d'Investigació Sanitària Illes Balears, (IdISBa), Palma de Mallorca, Spain
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Gao Q, Liu C, Qi Z, Zhai P, Qi J, Yang Z, Hu Y, Yuan X. Augmentation Mammoplasty With External Volume Expander-Assisted Autologous Fat Grafting in 305 Asian Patients. Aesthet Surg J 2022; 42:NP407-NP415. [PMID: 35182422 DOI: 10.1093/asj/sjac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND External volume expander (EVE)-assisted autologous fat grafting is suitable for breast augmentation, but no large sample study in Asia has confirmed this method. OBJECTIVES The authors reported their experience and outcomes in augmentation mammoplasty with EVE-assisted autologous fat grafting. METHODS A retrospective study was conducted in 305 female patients who underwent augmentation mammoplasty with EVE-assisted fat grafting between September 2012 and December 2020. Doctors utilized Crisalix (Crisalix S.A., Lausanne, Switzerland) for 3-dimensional (3D) imaging acquisition to measure the increase in breast volume to evaluate doctor satisfaction. The Preoperative Satisfaction with Breast and BREAST-Q questionnaires were employed to assess patients' preoperative and postoperative satisfaction, respectively. RESULTS The 305 female patients were aged 18 to 50 years (mean, 35.9 years). Among them, 68.52% were "very satisfied," 18.69% were "somewhat satisfied," 11.15% were "somewhat dissatisfied," and 1.64% were "very dissatisfied" based on BREAST-Q analysis, whereas 100% were dissatisfied according to the Preoperative Satisfaction with Breast questionnaire. Doctors employed Crisalix to measure the increase in breast volume to evaluate doctor satisfaction. The results showed 76.01% had an increase in breast volume of 150 to 250 mL or >250 mL and were "satisfied" and "very satisfied," respectively, 21.64% had an increase of 50 to 149 mL and were "somewhat satisfied," and 2.30% had an increase <50 mL and were "dissatisfied." There were no complications, such as obvious fat liquefaction, infection, or fat embolism. CONCLUSIONS Augmentation mammoplasty with EVE-assisted fat grafting is effective and satisfying in China. Crisalix for 3D imaging acquisition is convenient and effective in measuring breast volume. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Qiuni Gao
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Zuoliang Qi
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peiming Zhai
- Department of Plastic Surgery, the Fifth People’s Hospital of Hainan Province, Hainan, China
| | - Jun Qi
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenyu Yang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuling Hu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xihang Yuan
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wederfoort JLM, van Santbrink E, Hommes JE, Heuts EM, Van Kuijk SMJ, van der Hulst RRWJ, Piatkowski A. Donor Site Satisfaction Following Autologous Fat Transfer for Total Breast Reconstruction. Aesthet Surg J 2022; 43:40-48. [PMID: 35580058 PMCID: PMC9830977 DOI: 10.1093/asj/sjac125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND With evolving breast cancer survival and patient preferences, it is essential that reconstructive surgeons worldwide continue searching for the best reconstruction technique for patients. Autologous fat transfer (AFT) is a relatively new technique for total breast reconstruction that has already proven to be effective and safe with all advantages of autologous tissue. However, little is known about the aesthetic results and satisfaction concerning donor sites. OBJECTIVES The aim of this study was to measure donor site satisfaction following AFT for total breast reconstruction in breast cancer patients. METHODS Between May and August of 2021, participants of the BREAST- trial who were at least 24 months after their final reconstruction surgery were invited to complete an additional survey concerning donor sites. The BODY-Q was utilized for data collection. Results of AFT patients were compared with a control group of implant-based reconstruction patients who did not have a donor site. RESULTS A total of 51 patients (20 control, 31 intervention) completed the questionnaire. Satisfaction with body did not statistically differ between the groups. The most frequent complaint was contour irregularities (31 reports, 60.8%), with the least favorable donor site being thighs (23 reports, 53.5%) in the AFT group. CONCLUSIONS Satisfaction with body did not differ between breast cancer patients receiving AFT or implant-based reconstruction, meaning that large-volume liposuction does not aesthetically affect the utilized donor sites. Nevertheless, reconstructive surgeons should be aware of possible donor site complications, especially contour irregularities at the thighs, and discuss this with their patients.
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Affiliation(s)
- Jamilla L M Wederfoort
- Corresponding Author: Dr Jamilla Lonieke Maria Wederfoort, Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. E-mail: ; Instagram: @jamzz21
| | - Esther van Santbrink
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Juliette E Hommes
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Esther M Heuts
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive, and Hand Surgery, VieCuri Medical Center, Venlo, the Netherlands
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Vojdani A, Shoenfeld YY. Catastrophic Embolism Following Cosmetic Injection of Autologous Fat: Are Silicone-Treated Syringes the Only Suspects on the Crime Scene? Front Surg 2022; 9:867994. [PMID: 35615656 PMCID: PMC9124850 DOI: 10.3389/fsurg.2022.867994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Aristo Vojdani
- Immunosciences Lab. Inc., Los Angeles, CA, United States
- Cyrex Labs LLC, Phoeniz, AZ, United States
- Correspondence: Aristo Vojdani Yehuda Yulius Shoenfeld
| | - Yehuda Yulius Shoenfeld
- Ariel University, Ariel, Samaria, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, Ramat Gan, Israel
- Correspondence: Aristo Vojdani Yehuda Yulius Shoenfeld
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Khouri RK, Coleman SR, Yoshimura K, Rigotti G, Piccolo N, D’Amico R, Orgill DP. Commentary on: Safety and Effectiveness of Single Session Mega Volume Fat Grafting for Breast Augmentation: A Space Creating Concept and Clinical Experiences. Aesthet Surg J 2022; 42:NP589-NP591. [PMID: 35435212 DOI: 10.1093/asj/sjac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Sydney R Coleman
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kotaro Yoshimura
- Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan
| | | | | | | | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Goncalves R, Mota BS, Sobreira-Lima B, Ricci MD, Soares JM, Munhoz AM, Baracat EC, Filassi JR. The oncological safety of autologous fat grafting: a systematic review and meta-analysis. BMC Cancer 2022; 22:391. [PMID: 35410265 PMCID: PMC9004160 DOI: 10.1186/s12885-022-09485-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
Objective To present a systematic review of the literature and a meta-analysis evaluating the oncological safety of autologous fat grafting (AFG). Summary background data: AFG for breast reconstruction presents difficulties during follow-up radiological exams, and the oncological potential of grafted fat is uncertain. Previous studies confirmed that the fatty tissue could be transferred under a good condition suitable would not interfere with mammographic follow-up, although the issue of oncological safety remains. Methods We reviewed the literature published until 01/18/2021. The outcomes were overall survival (OS), disease-free survival (DFS), and local recurrence (LR). We included studies that evaluated women with breast cancer who undergone surgery followed by reconstruction with AFG. We synthesized data using the inverse variance method on the log-HR (log of the hazard ratio) scale for time-to-event outcomes using RevMan. We assessed heterogeneity using the Chi2 and I2 statistics. Results Fifteen studies evaluating 8541 participants were included. The hazard ratios (HR) could be extracted from four studies, and there was no difference in OS between the AFG group and control (HR 0.9, 95% CI 0.53 to 1.54, p = 0.71, I2 = 58%, moderate certainty evidence), and publication bias was not detected. The HR for DFS could be extracted from six studies, and there was no difference between the AFG group and control (HR 1.01, 95% CI 0.73 to 1.38, p = 0.96, I2 = 0%, moderate certainty evidence). The HR for LR could be extracted from ten studies, and there was no difference between the AFG group and control (HR 0.86, 95% CI 0.66 to 1.12, p = 0.43, I2 = 1%, moderate certainty evidence). Conclusion According to the current evidence, AFG is a safe technique of breast reconstruction for patients that have undergone BC surgery and did not affect OS, DFS, or LR. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09485-5.
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Affiliation(s)
- Rodrigo Goncalves
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Arnaldo, 251, Secretaria Cirúrgica, 4o andar, São Paulo, SP, CEP 01246-000, Brazil.
| | - Bruna Salani Mota
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Arnaldo, 251, Secretaria Cirúrgica, 4o andar, São Paulo, SP, CEP 01246-000, Brazil
| | - Bruno Sobreira-Lima
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Arnaldo, 251, Secretaria Cirúrgica, 4o andar, São Paulo, SP, CEP 01246-000, Brazil
| | - Marcos Desidério Ricci
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Arnaldo, 251, Secretaria Cirúrgica, 4o andar, São Paulo, SP, CEP 01246-000, Brazil
| | - José Maria Soares
- Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Mendonça Munhoz
- Disciplina de Cirurgia Plástica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto de Ensino e Pesquisa Hospital Sírio-Libanes, São Paulo, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Roberto Filassi
- Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Arnaldo, 251, Secretaria Cirúrgica, 4o andar, São Paulo, SP, CEP 01246-000, Brazil
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Fat Grafting: Basic Science, Techniques, and Patient Management. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e3987. [PMID: 35317456 PMCID: PMC8932485 DOI: 10.1097/gox.0000000000003987] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
In this review, a summary of the rich history of autologous fat grafting is provided, and a comprehensive summary of the science and theory behind autologous adipocyte transplantation, as well as the techniques commonly used is described. These include recipient site preparation, harvesting, processing, and engraftment. In addition, important considerations for preoperative and postoperative management are discussed to maximize graft retention. Special considerations in grafting to the breast, face, and buttocks are also summarized.
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58
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Mangialardi ML, Ozil C, Lepage C. Cosmetic Breast Augmentation Using Power-Assisted Liposuction and Lipofilling: A Prospective Study. Aesthetic Plast Surg 2022; 46:132-142. [PMID: 33983507 DOI: 10.1007/s00266-021-02309-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Autologous fat transfer is becoming a more and more widespread procedure in aesthetic breast surgery. Power-assisted technology produces oscillating reciprocal movements of cannula tip, which reproduce the motion of the operator's arm with lower amplitude. The power-assisted mechanism can be applied to the fat liposuction and injection phases. The aim of this study is to report our experience on autologous fat transfer in primary cosmetic breast augmentation using power-assisted liposuction and lipofilling (PALL), our surgical technique and on long-term cosmetic results, and patient-reported outcomes. MATERIALS AND METHODS A prospective observational study was performed including all patients who underwent PALL cosmetic breast augmentation. Collected data included patient's age, BMI, mean liposuction and fat injection volume, mean operating time, postoperative complications, mean number of grafting procedures required to achieve the desired outcome, cosmetic results and patient satisfaction. RESULTS A total of 43 patients were included with a mean follow-up of 13.32 months. Mean liposuction and injection volumes were 1884.54 mL and 399.03 mL, respectively. Mean number of grafting procedures was 1.27. With respect to aesthetic outcomes, the mean score for breast volume, shape, symmetry and donor site shape was 4.38, 4.22, 4.27 and 4.42, respectively. Regarding patient satisfaction, the mean score for breast volume, shape, symmetry and donor site shape was 4.22, 5, 5 and 4.77, respectively. CONCLUSION The current study is the first prospective report on primary cosmetic breast augmentation using PALL. Although our sample of patients is limited, our results showed that PALL primary breast augmentation is an efficient procedure, which leads to satisfactory results for both patients and surgeons. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Camille Ozil
- Hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200, Neuilly-sur-Seine, France
| | - Cristophe Lepage
- Hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200, Neuilly-sur-Seine, France
- Clinique Turin de Paris, 9 Rue de Turin, 75008, Paris, France
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Sahlender B, Windolf J, Suschek CV. Superoxide dismutase and catalase significantly improve the osteogenic differentiation potential of osteogenetically compromised human adipose tissue-derived stromal cells in vitro. Stem Cell Res 2022; 60:102708. [DOI: 10.1016/j.scr.2022.102708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/19/2022] [Accepted: 02/07/2022] [Indexed: 01/28/2023] Open
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Creating a Biological Breast Implant with an Omental Fat-Augmented Free Flap. Plast Reconstr Surg 2022; 149:832-835. [PMID: 35103642 DOI: 10.1097/prs.0000000000008963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Women with inadequate myocutaneous or fasciocutaneous soft-tissue donor sites for breast reconstruction after mastectomy are mostly limited to implants. Alternative substitutes are needed for those who do not want-or in whom there are contraindications for-implant-based reconstruction. The authors report a novel technique using an omental fat-augmented free flap to create an autologous breast mound that has comparable shape and projection to a breast implant. Three patients with breast cancer who desired unilateral reconstruction were identified in the period 2019 to 2020. All had insufficient traditional autologous sites and were averse to the use of implants. A nipple-sparing mastectomy was performed, and the omentum was laparoscopically harvested and fat-grafted ex vivo and then encased in acellular dermal matrix for microvascular anastomoses. The body mass indexes of the three patients were 17.6, 25, and 28.3 kg/m2. Each individual's mastectomy specimens and corresponding omentum plus fat-grafting weights were 113.7/228, 271/293, and 270/360 g. No postoperative complications occurred. The reconstructed breast remains soft, with stable breast volume at 6 months and without evidence of fat necrosis. This novel use of fat grafting into an omental flap enveloped in acellular dermal matrix, the omental fat-augmented free flap, provides a viable and successful autologous alternative for patients who are not candidates for traditional autologous breast reconstruction options because of body habitus or personal preference.
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Aesthetic Preferences of the Anterior Thigh as a Beauty Factor in Women. Plast Reconstr Surg Glob Open 2022; 10:e4055. [PMID: 35070601 PMCID: PMC8769123 DOI: 10.1097/gox.0000000000004055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
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Tripathy S, VinayKumar D, Mohsina S, Sharma R, Bhatia A. Histological analysis of the effect of nanofat grafting in scar rejuvenation. J Cutan Aesthet Surg 2022; 15:147-153. [PMID: 35965912 PMCID: PMC9364463 DOI: 10.4103/jcas.jcas_106_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Aims: Materials and Methods: Results: Conclusion:
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63
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Dayal A, Bhatia A, Hsu JTS. Fat grafting in aesthetics. Clin Dermatol 2022; 40:35-44. [DOI: 10.1016/j.clindermatol.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Satish C. Fat injection and its clinical applications. J Cutan Aesthet Surg 2022; 15:124-130. [PMID: 35965896 PMCID: PMC9364459 DOI: 10.4103/jcas.jcas_242_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Fat injection has been in application for more than two decades, and its usefulness has been well documented. In our article, we want to highlight the various applications and usefulness of this versatile technique. We also want to showcase the methods to ensure good results and maximize the uptake of fat grafts with minimal absorption. Our results in our series of 110 consecutive cases have been very encouraging, with excellent patient satisfaction.
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Tukiama R, Vieira RAC, Moura ECR, Oliveira AGC, Facina G, Zucca-Matthes G, Neto JN, de Oliveira CMB, Leal PDC. Oncologic safety of breast reconstruction with autologous fat grafting: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 48:727-735. [PMID: 34972623 DOI: 10.1016/j.ejso.2021.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/28/2021] [Accepted: 12/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Autologous fat grating has become increasingly popular as a breast reconstructive procedure. Nevertheless, preclinical studies show that fat transfer to a previous breast cancer site could activate latent cancer cells, creating a favourable environment for disease recurrence. A systematic review and meta-analysis was performed to investigate whether fat grafting increases the risk of locoregional recurrence in patients formerly treated for breast cancer. METHODS Based on PRISMA guidelines, a systematic review searching for randomised clinical trials and matched cohorts on the topic was performed in the electronic databases Pubmed, Embase, Web of Science, and Cochrane. The date of the last search was July 20, 2021. The meta-analysis assessed the comparison of locoregional recurrence between groups. RESULTS From a total of 558 publications, data from nine matched cohorts (1.6%) reporting on 4247 subjects (1590 and 2657 subjects, respectively, in lipofilling and control groups) were suitable for inclusion in the meta-analysis. Neither of the outcomes had a statistically significant difference for disease recurrence. For the primary outcome, comparing locoregional recurrence rates between groups, the incidence rate ratio was 0.92 (95% CI: 0.68-1.26; P = 0.620). CONCLUSION The present meta-analysis, which comprises the outcomes of the individual studies with the best current evidence on the topic so far, strengthens the evidence favouring the oncologic safety of lipofilling for breast reconstruction.
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Affiliation(s)
- Ricardo Tukiama
- Universidade Federal do Maranhão, Campus do Bacanga, Avenida dos Portugueses 1966, Prédio do Centro de Ciências Biológicas e da Saúde, 65080-805, São Luís, Maranhão, Brazil; Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Rua Antenor Duarte Viléla, 1331, 14784-400, Barretos, São Paulo, Brazil; Department of Gynaecology, Breast Diseases Division, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 632, 04024-002, São Paulo, Brazil.
| | - René A C Vieira
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Rua Antenor Duarte Viléla, 1331, 14784-400, Barretos, São Paulo, Brazil
| | - Ed C R Moura
- Universidade Federal do Maranhão, Campus do Bacanga, Avenida dos Portugueses 1966, Prédio do Centro de Ciências Biológicas e da Saúde, 65080-805, São Luís, Maranhão, Brazil
| | - Ana G C Oliveira
- Universidade Federal do Maranhão, Campus do Bacanga, Avenida dos Portugueses 1966, Prédio do Centro de Ciências Biológicas e da Saúde, 65080-805, São Luís, Maranhão, Brazil
| | - Gil Facina
- Department of Gynaecology, Breast Diseases Division, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 632, 04024-002, São Paulo, Brazil
| | - Gustavo Zucca-Matthes
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Rua Antenor Duarte Viléla, 1331, 14784-400, Barretos, São Paulo, Brazil
| | - João N Neto
- Universidade Federal do Maranhão, Campus do Bacanga, Avenida dos Portugueses 1966, Prédio do Centro de Ciências Biológicas e da Saúde, 65080-805, São Luís, Maranhão, Brazil
| | - Caio M B de Oliveira
- Universidade Federal do Maranhão, Campus do Bacanga, Avenida dos Portugueses 1966, Prédio do Centro de Ciências Biológicas e da Saúde, 65080-805, São Luís, Maranhão, Brazil
| | - Plínio da Cunha Leal
- Universidade Federal do Maranhão, Campus do Bacanga, Avenida dos Portugueses 1966, Prédio do Centro de Ciências Biológicas e da Saúde, 65080-805, São Luís, Maranhão, Brazil
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Munhoz AM, de Azevedo Marques Neto A, Maximiliano J. Optimizing Surgical Outcomes with Small-Volume Silicone Implants Associated with Autogenous Fat Grafting in Primary and Revision Breast Augmentation Surgery: Soft Weight Hybrid (SWEH) Concept. Aesthetic Plast Surg 2021; 46:1087-1103. [PMID: 34850252 DOI: 10.1007/s00266-021-02653-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/24/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Simultaneous association of autologous fat grafting (AFG) with silicone implants, defined as a hybrid procedure, has been proposed for breast augmentation (BA). In some patients, larger-volume implants may result in larger incisions, with long-term effects including implant palpability, soft tissue atrophy, and secondary ptosis. Some patients do not want large volume implants, or have insufficient soft tissue coverage. Recent improvements in AFG have led to new surgical options in BA for addressing these cases. OBJECTIVES This study combines AFG in BA using small-volume implants, known as the SWEH (soft weight hybrid) approach, and evaluates aesthetic advantages and outcomes following primary/secondary BA. METHODS 25 patients (50 breasts) underwent SWEH procedures; this approach was indicated when the overlying tissue was insufficient to adequately cover the implant and patients refused large-volume implants. Three-dimensional images were obtained using a Divina 3D scanner system (AX3 Technologies, Miami, USA) to assess breast volume (BV) and intermammary distance (IMD) during follow-up. RESULTS Mean patient age was 29.3 years (range: 21-42) and mean body mass index was 19.3 kg/m2 (15.3-27.2). The most common implant (SmoothSilk surface Round/Ergonomix style) volume was 180 cc (175-215), and patients received a mean volume of 125 cc of fat (89-168)/breast in the subcutaneous tissue. Preoperative average BV measurements were 236.85 cc (170-335). At 3 and 12 months post-procedure, the average BV values were 488.82 and 478.73cc, respectively (p=0.475). The average preoperative IMD was 31.76 mm (range, 22-43); at 3 and 12 months post-procedure, the average IMD was 20.47 and 20.94 mm, respectively (p=0.61). Postoperative complications included subcutaneous banding in the axilla (n = 1; 4%) and hypertrophic scarring (n = 1; 4%). Breast imaging exams were performed; in 2 breasts (8%) localized oil cysts were observed; no cases of suspicious calcifications, fat necrosis, or lumps were seen. Fat retention rate (1 year) was calculated by the difference between the BV expected with 100% fat intake and the real BV observed. In our sample we observed an average of 72.7 (range: 69.2-77.3, SD: 2.63) and 76.7 (range: 72.3-79.9, SD: 2.18) percent of fat intake on the right and the left breast respectively. No rippling, implant malposition, or infection was observed during a mean follow-up of 22 months (6-40). CONCLUSIONS SWEH is a useful surgical alternative that combines the benefits of AFG and implant-based augmentation, particularly with regard to soft tissue coverage, and avoids the limitations of larger-volume implants. The association of small-volume gel implants and smaller scars can yield satisfactory aesthetic outcomes. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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Affiliation(s)
- Alexandre Mendonça Munhoz
- Plastic Surgery Division, Hospital Sírio-Libanês Rua Mato Grosso, 306 cj.1706 Higienópolis, São Paulo, 01239-040, Brazil.
- Brazilian Society of Plastic Surgery (SBCP), São Paulo, Brazil.
- Breast Surgery Group, Plastic Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil.
- Plastic Surgery Department, Hospital Moriah, São Paulo, Brazil.
| | - Ary de Azevedo Marques Neto
- Plastic Surgery Division, Hospital Sírio-Libanês Rua Mato Grosso, 306 cj.1706 Higienópolis, São Paulo, 01239-040, Brazil
- Brazilian Society of Plastic Surgery (SBCP), São Paulo, Brazil
- Plastic Surgery Department, Hospital Moriah, São Paulo, Brazil
- Hospital Moriah, São Paulo, Brazil
| | - João Maximiliano
- Brazilian Society of Plastic Surgery (SBCP), São Paulo, Brazil
- Plastic Surgery Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Hamidian Jahromi A, Horen SR. Editorial: feasibility, complications, and cosmetic outcomes of immediate autologous fat grafting during breast-conserving surgery for early-stage breast cancer. Gland Surg 2021; 10:2885-2889. [PMID: 34804876 DOI: 10.21037/gs-21-563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Alireza Hamidian Jahromi
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sydney R Horen
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
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Qin Z, Yu Z, Song B. Efficacy and Safety of External Volume Expansion (EVE) on Fat Grafting: A Systematic Review and Single-Arm Meta-Analysis. J Plast Reconstr Aesthet Surg 2021; 75:1073-1082. [PMID: 34930704 DOI: 10.1016/j.bjps.2021.11.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/02/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The autologous fat grafting is commonly used for reconstructive or aesthetic purposes. However, due to the huge variation in methods, its retention rate varies a lot. External volume expansion (EVE) has been used to treat recipient sites of fat grafting. Concerns have been raised regarding its efficacy and safety. METHODS We have searched PubMed, EMBASE, and the Cochrane Library for studies on EVE-assisted fat grafting published from 2000 to 2020. A meta-analysis was conducted to pool the retention rate. The incidence of complications was assessed for reconstructive or aesthetic purposes. RESULTS The 11 included studies involved 1152 patients with operations on 1794 breasts. Four studies were included in the meta-analysis. The pooled retention rate was 65% [95%CI 49, 79]. Eight studies reported the complications. The total complication incidence was 34%, which is 35% for the aesthetic group and 33% for the reconstructive group. The complication rate was not obviously different between the two groups. CONCLUSIONS The study shows that the EVE-assisted fat grafting has better retention rate than traditional fat grafting. However, the data showed that the complication rate was much higher in the EVE-assisted group.
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Affiliation(s)
- Zijin Qin
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, People's Republic of China
| | - Zhou Yu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, People's Republic of China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, People's Republic of China.
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Klinger M, Losurdo A, Lisa AVE, Morenghi E, Vinci V, Corsi F, Albasini S, Leonardi MC, Jereczek-Fossa BA, Veronesi P, Rietjens M, Fabiocchi L, Santicchia S, Klinger F, Loreti A, Fortunato L, Bocchiotti MA, Nicolò FA, Stringhini P, Parodi PC, Rampino E, Guarneri V, Pagura G, Venezia ED, Meneghini G, Kraljic T, Persichetti P, Barone M, Vaia N, Zerini I, Grimaldi L, Riccio M, Aquinati A, Bassetto F, Vindigni V, Ciuffreda L, Tinterri C, Santoro A. Safety of autologous fat grafting in breast cancer: a multicenter Italian study among 17 senonetwork breast units autologous fat grafting safety: a multicenter Italian retrospective study. Breast Cancer Res Treat 2021; 191:355-363. [PMID: 34755240 DOI: 10.1007/s10549-021-06444-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/01/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Autologous fat grafting (AFG), defined as the re-implant to the breast of fat tissue from different body areas, has been firstly applied to esthetic plastic surgery and then has moved to reconstructive surgery, mainly used for scar correction and opposite breast altering. Nevertheless, due to the potentially unsafe stem-like properties of adipocytes at the tumoral bed level, no clear evidence of the procedure's oncological safety has been clearly documented at present. PATIENTS AND METHODS We retrospectively collected data of early breast cancer (BC) patients from 17 Italian Breast Units and assessed differences in terms of locoregional recurrence rate (LRR) and locoregional recurrence-free survival (LRFS) between patients who underwent AFG and patients who did not. Differences were analyzed in the entire cohort of invasive tumors and in different subgroups, according to prognostic biological subtypes. RESULTS With a median follow-up time of 60 months, LRR was 5.3% (n = 71) in the matched population, 3.9% (n = 18) in the AFG group, and 6.1% (n = 53) in the non-AFG group, suggesting non-inferiority of AFG (p = 0.084). Building Kaplan-Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR 0.73, 95% CI 0.41-1.30, p = 0.291). The same effect, in terms of LRFS, was also documented among different biological subtypes (luminal-like group, aHR 0.76, 95% CI 0.34-1.68, p = 0.493; HER2 enriched-like, aHR 0.89, 95% CI 0.19-4.22, p = 0.882; and TNBC, aHR 0.61, 95% CI 0.12-2.98, p = 0.543). CONCLUSIONS Our study confirms in a very large, multicenter cohort of early BC patients that, aside the well-known benefits on the esthetic result, AFG do not interfere negatively with cancer prognosis.
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Affiliation(s)
- Marco Klinger
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, University of Milan, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Agnese Losurdo
- UO of Medical Oncology, Department of Oncology and Hematology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Andrea V E Lisa
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, University of Milan, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Valeriano Vinci
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, University of Milan, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Fabio Corsi
- Department of Biomedical and Clinical Sciences, "Luigi Sacco", Università di Milano, Milan, Italy
- Department of Surgery, Breast Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Sara Albasini
- Department of Surgery, Breast Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Barbara A Jereczek-Fossa
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Paolo Veronesi
- Department of Oncology and Hematology, University of Milan, Milan, Italy
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mario Rietjens
- Division of Plastic and Reconstructive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Fabiocchi
- Plastic Surgery Unit, Breast Unit, Rimini Santarcangelo Hospital, Rimini, Italy
| | - Sonia Santicchia
- Department of Breast Diagnosis, Breast Unit, Rimini Santarcangelo Hospital, Rimini, Italy
| | - Francesco Klinger
- University of Milan, Reconstructive and Aesthetic Plastic Surgery School - MultiMedica Holding S.p.A.- Plastic Surgery Unit - Sesto San Giovanni, Milan, Italy
| | - Andrea Loreti
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Lucio Fortunato
- Breast Surgery Unit, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Maria A Bocchiotti
- Department of Plastic and Reconstructive Surgery, Università Città della Salute e della Scienza, Torino, Italy
| | - Fulvio A Nicolò
- Department of Plastic and Reconstructive Surgery, Università Città della Salute e della Scienza, Torino, Italy
| | - Paolo Stringhini
- Reconstructive Surgery, Fondazione Poliambulanza Brescia, Brescia, Italy
| | - Pier Camillo Parodi
- Department of Medical, Experimental and Clinical Sciences - Plastic and Aesthetic Surgery, University of Udine, Udine, Italy
| | - Emanuele Rampino
- Department of Medical, Experimental and Clinical Sciences - Plastic and Aesthetic Surgery, University of Udine, Udine, Italy
| | - Valentina Guarneri
- UO of Clinical Oncology, Università di Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy
- Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | | | - Erica Dalla Venezia
- Department of Plastic and Reconstructive Surgery, ULSS3 Serenissima, Mestre, Italy
| | | | - Tanja Kraljic
- Breast Unit, Azienda ULSS8 Berica, Vicenza, Montecchio Maggiore, Italy
| | - Paolo Persichetti
- Department of Plastic and Reconstructive Surgery, Medico University of Rome, Campus Bio, Rome, Italy
| | - Mauro Barone
- Department of Plastic and Reconstructive Surgery, Medico University of Rome, Campus Bio, Rome, Italy
| | - Nicola Vaia
- Department of Plastic and Reconstructive Surgery, Belcolle Hospital, Viterbo, Italy
| | - Irene Zerini
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Grimaldi
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Michele Riccio
- Department of Plastic and Reconstructive Hand Surgery, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Angelica Aquinati
- Regenerative Surgery Research and Formation Center, Accademia del Lipofilling, Montelabbate, Italy
| | - Franco Bassetto
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Luigi Ciuffreda
- Breast Surgery Unit, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Corrado Tinterri
- Breast Surgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Armando Santoro
- UO of Medical Oncology, Department of Oncology and Hematology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Ishii N, Harao M, Kiuchi T, Sakai S, Uno T, Ando J, Kishi K. Making the upper edge of a silicone breast implant invisible by fat onlay-grafting harvested from the affected inframammary fold. Gland Surg 2021; 10:2656-2662. [PMID: 34733715 DOI: 10.21037/gs-21-425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/30/2021] [Indexed: 11/06/2022]
Abstract
Background In silicone breast implant (SBI)-based breast reconstructions, aesthetic outcomes are often low due to the visible upper edge of the SBI. To ameliorate this, grafting fat harvested from the SBI operative field has not been reported to date. Therefore, we aimed to develop a novel technique for fat onlay-grafting, harvested from the inframammary fold (IMF) of the reconstructed breast, and investigate its usefulness. Methods A total of 90 patients who underwent SBI-based breast reconstruction after a simple mastectomy were included in this study. The harvested fat was recorded by weight and grafted evenly to the medial and median upper edge of the SBI on the pectoralis major muscle. We applied this technique to 30 patients (fat onlay-grafting group) and compared them with the 60 patients (no-grafting group) who did not undergo our technique using the postoperative 1-year aesthetic outcome scores of the medial and median upper edge of the SBI. Furthermore, we investigated the correlation between the weight of harvested fat and body mass index. Results No postoperative wound complications occurred, and infection, hardened fat, and fat lysis were not found in the fat onlay-grafting group. The medial and total aesthetic outcome scores in the fat onlay-grafting group were significantly higher than those in the no-grafting group (P<0.05). The average weight of harvested fat was 11.9 [5-32] g. The correlation between the weight of the harvested fat and body mass index was significantly positive (R2=0.7119, P<0.05). Conclusions Our technique made the upper edge of the SBI invisible. Further, it was simple and less invasive with safe augmentation. Therefore, we believe that this technique can contribute to better aesthetic outcomes in SBI-based breast reconstruction.
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Affiliation(s)
- Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Michiko Harao
- Department of Breast Surgery, Jichi Medical University, Tochigi, Japan
| | - Tomoki Kiuchi
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Shigeki Sakai
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Takahiro Uno
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Jiro Ando
- Department of Breast Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
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Roy PG, Yan Z, Nigam S, Maheshwari K. Aesthetic breast surgery: putting in context-a narrative review. Gland Surg 2021; 10:2832-2846. [PMID: 34733731 DOI: 10.21037/gs-20-892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/12/2021] [Indexed: 01/13/2023]
Abstract
Objective This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation, reduction, and mastopexy. The paper also outlines various approaches and controversies as well as complications such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII) which are increasingly being recognised and becoming a challenge to manage. Background Changing trends of aesthetic breast surgery over the decades has warranted a continuous evolution of this field. The ability to deliver safe and appropriate care is dependent upon sound reconstructive principles and proper training. The lack of uniformity in either is a cause of concern. The impact of social media and changing perception of body image can also no longer be overlooked in the field of aesthetics and reconstruction. Methods Review of literature including recent journals, textbook chapters, online databases like PubMed, and current government and surgical society guidelines. Conclusions Breast reconstruction is based on sound surgical principles and it is imperative to follow these for the practice of this speciality. There are two important issues that revolve around this aspect of surgery. First relates to the urgent need to invest time and effort in improving regulations and outcomes in the cosmetic surgery industry. Second, it is crucial to promote and prioritize the development and training in this field as the principles of aesthetic breast surgery underpins oncoplastic breast surgery for management of cancer.
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Affiliation(s)
- Pankaj G Roy
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Zhiyan Yan
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Shashank Nigam
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Kavish Maheshwari
- Department of Plastic Surgery, Bedfordshire Hospitals NHS Trust, Bedfordshire, UK
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Bergeret-Galley C, Al Madani O. Invited Discussion on: 'Liquid Phase Concentrated Growth Factor Improves Autologous Fat Graft Survival in Vivo in Nude Mice'. Aesthetic Plast Surg 2021; 45:2423-2425. [PMID: 34142196 DOI: 10.1007/s00266-021-02392-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
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73
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Zhang X, Mu D, Lin Y, Wang C, Xu B, Yang Y, Li W, Liu Y, Li H. Prediction of the Postoperative Fat Volume Retention Rate After Augmentation Mammoplasty with Autologous Fat Grafting: From the Perspective of Preoperative Inflammatory Level. Aesthetic Plast Surg 2021; 46:2488-2499. [PMID: 34599352 DOI: 10.1007/s00266-021-02604-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postoperative fat volume retention rate (PFVRR) after augmentation mammoplasty with autologous fat grafting is highly variable on an individual basis and challenging to be predicted. However, at present, there is a lack of further research on the relevant preoperative patient's self-related influencing factors. The early inflammatory response degree, directly influenced by preoperative inflammatory level, is an indispensable part of angiogenesis, which is a key factor in adipocyte survival. METHODS A retrospective review was conducted of patients who underwent breast augmentation with autologous fat grafting performed by a senior surgeon. Preoperative patient demographics and laboratory findings relevant to inflammatory level, such as monocyte to lymphocyte ratio (MLR), were included as the independent variables. The PFVRR more than 3 months after the operation was included as the dependent variable. Key factors influencing the PFVRR were analyzed. RESULTS Sixty-three patients were included. The total volume of bilateral fat injection was 375.00 (range, 320.00-400.00) mL, and the long-term bilateral volumetric change was 106.98 (range, 69.90-181.58) mL. The mean PFVRR was 35.36% ± 15.87%, and the preoperative MLR was an independent positive influencing factor of it, while the lymphocyte (L) count was negative. By ROC curve analysis, a value of MLR equal to 0.23 was the diagnostic cut-off point for whether PFVRR was greater than 50%, and its area under the curve was 0.870, with a sensitivity of 93.33% and a specificity of 81.25%. The other hematological parameters and demographics such as age, body mass index, and donor site were not significantly correlated with the PFVRR. CONCLUSION Preoperative peripheral blood inflammatory indicators can influence the PFVRR, with the MLR positively and L count negatively. Based on the diagnostic threshold of MLR = 0.23 derived from this study, clinicians can make reasonable predictions of whether half of the injected fat volume would be retained based on preoperative blood routine tests that are readily available. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Ren J, Kong W, Lu F, Li Y. Adipose-derived stem cells (ADSCs) inhibit the expression of anti-apoptosis proteins through up-regulation of ATF4 on breast cancer cells. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1300. [PMID: 34532437 PMCID: PMC8422111 DOI: 10.21037/atm-21-3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/06/2021] [Indexed: 12/09/2022]
Abstract
Background While current basic studies indicate adipose-derived stem cells (ADSCs) can promote cell proliferation, clinical trials have shown no significant difference in breast cancer recurrence rates for patients with or without autologous fat grafting (AFG). In this study we attempted to explore the underlying mechanism for these contradictory results. Methods ADSCs and umbilical mesenchymal stem cells (UMSCs) were co-cultured with breast cancer cells (MCF-7 and MDA-MB-231), and the cell viability analyzed by CCK-8 cell proliferation assay, TUNEL assay and immunofluorescence assay. In addition, real-time quantitative polymerase chain reaction (RT-qPCR) experiments and Western blot analysis were used to detect the mRNA and protein expression of activating transcription factor 4 (ATF4) and its downstream gene (MCL1 & BCL2), respectively. Results Co-cultured ADSCs could promote cell proliferation and cell apoptosis, and up-regulate ATF4 expression both in MCF-7 and MDA-MB-231. While co-cultured UMSCs could only promote cell apoptosis in MCF-7. Interestingly, we found that when co-cultured ADSCs, the expression of MCL1 and BCL2 protein was decreased, even if their mRNA expression was up-regulated both in MCF-7 and MDA-MB-231. Conclusions Co-cultured ADSCs can up-regulate ATF4 expression, then interfere with the translation process of MCL1 and BCL2 mRNA and induce cell apoptosis. These data provide insight into the safety characteristics of AFG.
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Affiliation(s)
- Jing Ren
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ye Li
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Schop SSJ, Hommes JE, Krastev TK, Derks D, Larsen M, Rakhorst HI, Schmidbauer U, Smit JM, Tan T, Wehrens K, de Wit T, van der Hulst RRWJ, Piatkowski de Grzymala AA. BREAST trial study protocol: evaluation of a non-invasive technique for breast reconstruction in a multicentre, randomised controlled trial. BMJ Open 2021; 11:e051413. [PMID: 34531218 PMCID: PMC8449986 DOI: 10.1136/bmjopen-2021-051413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Pioneers have shown that it is possible to reconstruct a full breast using just autologous fat harvested by liposuction or autologous fat transfer (AFT). This study describes the first multicentre randomised study protocol to thoroughly investigate the effectiveness of AFT to reconstruct full breasts following mastectomy procedures (primarily and delayed). METHODS AND ANALYSIS This study is designed as a multicentre, randomised controlled clinical superiority trial with a 1:1 allocation ratio. A total of 196 patients (98 patients per treatment arm) are aimed to be included. Patients who wish to undergo breast reconstruction with either one of the two techniques are randomly allocated into the AFT group (intervention) or the tissue-expander/prosthesis group (control). The primary outcome measure for the quality of life is measured by the validated BREAST-Q questionnaire. ETHICS AND DISSEMINATION Approval for this study was obtained from the medical ethics committee of Maastricht University Medical Centre/Maastricht University; the trial has been registered at ClinicalTrials.gov. The results of this randomised controlled trial will be presented at scientific meetings as abstracts for poster or oral presentations and published in peer-reviewed journals. TRIAL STATUS Enrolment into the trial has started in October 2015. Data collection and data analysis are expected to be completed in December 2021. TRIAL REGISTRATION NUMBER NCT02339779.
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Affiliation(s)
- Sander S J Schop
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Juliette E Hommes
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Todor K Krastev
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daniëlle Derks
- Plastic, Reconstructive, and Hand Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - Mikko Larsen
- Plastic, Reconstructive, and Hand Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - HInne Rakhorst
- Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Plastic, Reconstructive and Hand Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Ute Schmidbauer
- Plastic, Reconstructive, and Hand Surgery, Hospital Group Twente Hengelo, Hengelo, The Netherlands
| | - Jan Maerten Smit
- Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Tik Tan
- Plastic, Reconstructive, and Hand Surgery, Medical Centre Haaglanden, Den Haag, The Netherlands
- Plastic Surgery, HMC The Hague, Barendrecht, The Netherlands
| | - Kim Wehrens
- Plastic, Reconstructive, and Hand Surgery, Medical Centre Haaglanden, Den Haag, The Netherlands
| | - Thijs de Wit
- Plastic, Reconstructive, and Hand Surgery, Amphia Hospital, Breda, The Netherlands
| | - Rene R W J van der Hulst
- Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Saponaro G, Pelo S, Gasparini G, Todaro M, Cerbellli E, Moro A, Doneddu P. Approach to Fronto-Orbital Sequelae in Anterior Synostotic Plagiocephaly: Our Flow Chart Based on Di Rocco Classification. J Craniofac Surg 2021; 32:1986-1989. [PMID: 34516067 DOI: 10.1097/scs.0000000000007389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Anterior synostotic plagiocephaly recognizes the synostosis of one of the hemicoronal sutures as a cause and can manifest itself with varying degrees of severity. Clinically it presents a reduction of the sagittal growth of the affected side and flattening of the frontoparietal complex. MATERIALS AND METHODS The authors retrospectively examined our case sample dividing it into 3 groups based on the Di Rocco classification. For each category, we assessed the extent of facial alterations at the end of skeletal growth and retrospectively analyzed the surgical options aimed at correcting aesthetic and skeletal deficits. RESULTS The authors found that predictable results could be obtained by standardizing the surgical procedure based on Di Rocco's classification groups; in particular, the authors achieved satisfactory results by assigning a specific surgical procedure to each class.
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Affiliation(s)
- Gianmarco Saponaro
- Maxillo-Facial Unit, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, Italy
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Palpable Nodules After Autologous Fat Grafting in Breast Cancer Patients: Incidence and Impact on Follow-up. Aesthetic Plast Surg 2021; 47:503-511. [PMID: 34435220 DOI: 10.1007/s00266-021-02530-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Autologous fat grafting (AFG) is a promising breast reconstruction technique, following surgery. However, fat necrosis after AFG can cause palpable nodules, inducing anxiety and prompting additional investigations. We aimed to determine the occurrence rate and to identify the risk factors of palpable nodules in breast cancer patients prompting complementary explorations. MATERIALS AND METHODS We retrospectively reviewed the computerized files of consecutive breast cancer patients who underwent AFG after mastectomy or breast conservative treatment (BCT) at our center from January 2013 to December 2016. We collected data regarding palpable nodule incidences and suspicious breast imaging findings that led to additional explorations. RESULTS Of the 252 patients reviewed, 222 (88%) underwent AFG for breast reconstruction, while 30 (12%) underwent AFG for correction of defects after BCT. The follow-up period ranged from 0 to 74 months (median: 27 months), and 201 patients had follow-ups beyond 1 year. Of the 252 patients, 66 (26.2%) underwent at least one control imaging and 24 (10%) underwent a biopsy, including 6 (2.4%) locoregional recurrence. Sixty patients (24%) were diagnosed with nodules during follow-ups. Among them, 52 (87%) patients had additional imaging, and 17 patients (28%) had a biopsy, including 82% benign histology. Patients with BCT had significantly more palpable nodules at 1 year than patients who underwent total mastectomy (odds ratio = 2.50, 95% confidence interval: 1.04. 6.03, p = 0.04). CONCLUSION This study underlines the importance of preoperative patient information. This intervention and its follow-up should be reserved for experienced teams to limit unnecessary additional explorations. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Complications and Surgical Treatment of Breast Augmentation Using Autologous Fat Transfer and Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3734. [PMID: 34414053 PMCID: PMC8367042 DOI: 10.1097/gox.0000000000003734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Background Breast augmentation with autologous fat grafting or hyaluronic acid injection requires minimal loss of healthy tissue. With an increasing trend of breast augmentation with these fillers, accompanying complications have also increased. Patients with complications often complain of induration, cyst formation, calcification, and infection, which require surgical treatment. We will discuss these complications and their surgical treatment through our experience of cases. Methods This retrospective study included 20 patients who all required surgical treatment due to breast augmentation complications such as induration, cyst formation, calcification, and infection, and who visited us between May 2007 and June 2018. The patients' ages ranged from 25 to 63, and the mean age was 39.9. The material used for breast augmentation was fat for 17 cases, and hyaluronic acid, paraffin, and silicon for one case each. The results were analyzed through plastic surgeons at our hospital. Results We performed a zigzag incision in the peri-areola margin to 17 of 18 patients for complications of autologous fat grafting and hyaluronic acid injection. The one excluded patient required an adipo-fascial flap from an inframammary fold incision. For one patient with silicon injection complication and one patient with paraffin injection complication, each required mammary gland resection. Conclusions A zigzag incision in the peri-areolar margin was useful for treating complications of breast augmentation with autologous fat grafting and hyaluronic acid injection. All cases resulted in inconspicuous fine scars, with high patient satisfaction. However, this incision was insufficient to remove injected silicon and paraffin.
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Shi W, Torres-de la Roche LA, Ritter H, Dong J, Zeng JJ, Jiang YC, Zhuo R, De Wilde RL. An innovative oncoplastic technique for immediate small to medium volume breast reconstruction in lower inner quadrant cancer: The Zhuo-technique. Ann Med Surg (Lond) 2021; 68:102576. [PMID: 34367636 PMCID: PMC8326341 DOI: 10.1016/j.amsu.2021.102576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Insufficient glandular tissue in the lower quadrant of the breast is the main source of difficulty in repairing defects after oncoplastic surgery. Especially in small to medium sized breasts, this issue is more common. Here, we describe a novel oncoplastic approach that could help to solve this problem. Materials and methods Retrospective analysis of breast cancer patients with tumors in the lower inner quadrants, who underwent Zhuo's technique between January 2017 and August 2019. Aesthetic outcomes were evaluated in terms of the Paris Breast Center's 5-point scale. The work was reported according to the STROCSS criteria. Results Nine patients (mean age 54 years) with small to medium volume breast received Zhuo's oncoplastic technique after tumor excision. The mean size tumor was 18.0 mm. The median follow-up time was 27.0 months. Sentinel lymph node biopsy results for all patients were negative. None of the patients had local recurrences or metastases and postoperative complications were not observed. Seven patients (77.8%) achieved aesthetic scores of 5 and two patients (22.2%) achieved 4 points. Conclusions Zhuo's oncoplastic technique could provide a favorable and flexible surgical approach for small to medium volume breast with tumors of the lower inner quadrant with a low risk of recurrence and good aesthetic results. Protocol register Chinese clinical trial register No. ChiCTR2100043484. Defects after oncoplastic surgery is complicated by a lack of glandular tissue specially in case of small volume breasts. The Zhuo-technique generates a flexible pedicle flap from the upper abdomen to fill the defect area. The Zhuo-technique allows sufficient tissue transposition improving the postsurgical aesthetic appearance.
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Affiliation(s)
- Wenjie Shi
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, 26121, Oldenburg, Germany
| | | | - Henning Ritter
- Director Sino-European Brest Care Nurse School in Guilin, PR China
| | - Jie Dong
- Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin TCM Hospital of China, Guilin, 541002, Guang Xi, PR China
| | - Jia-Jia Zeng
- Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin TCM Hospital of China, Guilin, 541002, Guang Xi, PR China
| | - Yi-Cheng Jiang
- Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin TCM Hospital of China, Guilin, 541002, Guang Xi, PR China
| | - Rui Zhuo
- Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin TCM Hospital of China, Guilin, 541002, Guang Xi, PR China
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, 26121, Oldenburg, Germany
- Corresponding author. University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Germany. Postal address: Georgestrasse 12, 26121, Oldenburg, Germany.
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Olaru I, Sava A, Tamaş C, Costea CF, Dumitrescu GF, Paşca AS, Olaru FŞ, Stamate T. The significance of erythropoietin and insulin administration on survival of fat tissue after autologous fat transplantation in Wistar rats. An experimental study. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:1143-1151. [PMID: 34171063 PMCID: PMC8343588 DOI: 10.47162/rjme.61.4.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Autologous fat transfer is widely used by plastic surgeons for aesthetic and reconstructive purpose, but it has a great disadvantage because of its high variability rate of resorption. Numerous studies have examined the use of different agents to increase the viability of fat grafts. The results were discouraging because the use of a single angiogenic factor to stimulate fat graft angiogenesis may be inappropriate. We proposed to use two pharmacological factors, erythropoietin (EPO) and insulin (INS), in order to decrease the resorption rate, to improve graft vascularization, and to reduce the number of complications. Twenty-four Wistar male rats were randomly divided in four groups (I–IV) of six animals each. The rats belonging to control group were given autologous transfer of simple fat. In group II, the graft was improved with EPO, in group III with INS, and in group IV both pharmacological agents were administered. Histological evaluation of the grafts at two months after injection demonstrated adipocyte survival in all four groups. The volume of the graft has progressively decreased in all groups and the difference in graft volume at one and two months after transplantation was not significant. The highest maintenance of fat graft volume (95%) at two months was observed in group IV, followed by group II and group III. Necrotic cystic changes and increased fibrosis were most extensive in the control group. The combination of INS with EPO may have a synergistic and additive effect. Efficient administration and dose optimization of these growth factors are important things to consider in the future.
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Affiliation(s)
- Iulia Olaru
- Department of Morpho-Functional Sciences I, Department of Surgery I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; ,
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81
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Wu Y, Hu F, Li X, Yin G. Autologous Fat Transplantation for Aesthetic Breast Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J 2021; 41:NP402-NP429. [PMID: 33655292 DOI: 10.1093/asj/sjaa364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Autologous fat transplantation has already become a part of clinical practice for aesthetic breast augmentation even though evidence regarding its efficacy is still lacking. OBJECTIVES The authors sought to determine the current worldwide status and efficacy, techniques, and oncologic safety on this subject. METHODS PubMed, EMBASE, and Cochrane Library databases were searched to identify all relevant studies. RESULTS Eighty-four articles published between 1987 and April 2020, consisting of 6468 patients, were included, and 64 studies consisting of 5162 unique patients were included in the meta-analysis. Most studies had a low level of evidence (levels 2b-5); In this meta-analysis, there were 17 prospective cohort studies, 4 retrospective cohort studies, 6 case-control studies, and 38 case series. The publications were from 21 countries. Indications for autologous fat transplantation were aesthetic augmentation (93.2%) and congenital malformation (6.8%). Among the 5162 patients, 2 cases (0.04%) of cancer were reported. The meta-analysis revealed very high overall patient and surgeon satisfaction rates of 93% and 87%, respectively. Overall, only 1.56 sessions were needed to achieve the desired result. Long-term survival was calculated to be approximately 60% to 70% at 1-year follow-up. Only 8% of procedures resulted in clinical complications, and 5% of patients required biopsy because of abnormal clinical or radiological findings. CONCLUSIONS Autologous fat transplantation seems to be a major tool in aesthetic breast augmentation. Preoperative patient selection is essential but under-reported. Future research should focus on evaluating the technical and patient factors influencing the rate of fat survival and its oncological safety. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Yingjie Wu
- Department of Plastic and Aesthetic Surgery, Guangxi Medical University First Affiliated Hospital, Nanning City, Guangxi, China
| | - Feng Hu
- Department of Orthopaedics, Guangxi Medical University Second Affiliated Hospital, Nanning City, Guangxi, China
| | | | - Guoqian Yin
- Department of Plastic and Aesthetic Surgery, Guangxi Medical University First Affiliated Hospital, Guangxi Medical University, Nanning City, Guangxi, China
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Munhoz AM, de Azevedo Marques Neto A, Maximiliano J. Subfascial Ergonomic Axillary Hybrid (SEAH) Breast Augmentation: A Surgical Approach Combining the Advantages of Incision, Pocket, Silicone Gel, and Fat Grafting in Primary and Revision Breast Augmentation Surgery. Aesthet Surg J 2021; 41:NP364-NP384. [PMID: 33480969 DOI: 10.1093/asj/sjab029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Simultaneous application of the axillary approach (AA) with the subfascial pocket (SF) has been proposed for breast augmentation (BA) surgery. New silicone implant technology and recent improvements in autologous fat grafting (AFG) have ushered in a new era for BA. OBJECTIVES The aim of this study was to present the combined subfascial ergonomic axillary hybrid (SEAH) method and evaluate its aesthetic benefits after primary/secondary BA. METHODS In total, 42 patients (84 breasts) underwent BA with the SEAH technique; this approach was indicated when the overlying tissue was insufficient to adequately cover the implant. RESULTS Mean patient age was 34.6 years (range, 28-56 years), mean BMI was 18.8 kg/m2 (range, 14.4-26.1 kg/m2). The most common implant (Motiva SmoothSilk surface Ergonomix style) volume was 255 cc (range, 175-355 cc), patients received a mean fat volume of 96 mL (range, 60-145 mL) per breast in the subcutaneous tissue. The average lower pole stretch value was 40.5% (21.75 mm) and 13.1% (9.9 mm) for preoperative to 10 days postprocedure and 10 days to 18 months postprocedure, respectively. Postoperative complications included subcutaneous banding in the axilla (n = 3, 7.1%), small wound dehiscence (n = 1, 2.3%), and hypertrophic scarring (n = 1, 2.3%). No rippling, implant malposition, infection, or fat necrosis was observed during a mean follow-up of 18 months (range, 6-32 months). CONCLUSIONS SEAH is a useful and versatile technique combining the benefits of AFG and implant-based augmentation, particularly with regard to soft tissue coverage, and avoids the limitations of the submuscular position. The combination of ergonomic gel implants and a SF pocket can yield satisfactory aesthetic outcomes. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | - João Maximiliano
- Plastic Surgery Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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83
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de Arruda EGP, Munhoz AM, Matsumoto W, Ueda T, Montag E, Okada A, Coudry RDA, de Castro I, Gemperli R. Impact of Fat Graft Thickness and Harvesting Technique on Adipocyte Viability in a New Porcine Experimental Model: An Immunohistochemical Analysis. Aesthet Surg J 2021; 41:NP616-NP630. [PMID: 32875312 DOI: 10.1093/asj/sjaa256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Autologous fat grafting (AFG) has been employed in surgical practice as a filling method. However, controversies remain on the specifics of this technique. So far, few relevant experimental large animal studies have objectively assessed factors related to AFG integration. OBJECTIVES This study utilized an experimental, medium-sized animal model to compare the feasibility of AFG collected employing 2 different techniques with instruments of distinct thicknesses. METHODS Twenty minipigs (Sus scropha domesticus) were subjected to AFG harvesting via en bloc resection utilizing 3- (Group I) and 5-mm-diameter (Group II) round punch blades (PBs) and liposuction (LS) with 3- (Group III) and 5-mm-diameter cannulas (Group IV). Both samples were grafted intramuscularly (biceps femoralis). Hematoxylin and eosin staining was employed to identify intact adipocytes, fat necrosis, fibrosis, inflammation, and oil cysts. Immunohistochemical staining (perilipin-A, tumor necrosis factor alfa, and cluster of differentiation number 31) was utilized to quantify the feasibility of adipocytes, tissue necrosis, and neoangiogenesis, respectively. RESULTS Hematoxylin and eosin analysis showed that fat necrosis and histiocyte presence were significantly lower in the AFG harvested utilizing a PB than in LS. For perilipin-A, a statistical difference was observed between subgroups I and III (P = 0.001) and I and IV (P = 0.004). Instrument diameter had no effect on graft integration in comparisons between groups II and III (P = 0.059) and II and IV (P = 0.132). CONCLUSIONS In this experimental study, fat collected utilizing a PB demonstrated higher adipocyte viability than fat collected with LS. The diameter of the collection instruments, whether PB or LS, had no effect on graft integration.
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Affiliation(s)
- Eduardo Gustavo Pires de Arruda
- Department of Surgery, Plastic Surgery Division, Cancer Institute of Estado de São Paulo, University of São Paulo School of Medicine, Hospital Sírio-Libanês, São Paolo, Brazil
| | | | | | - Thiago Ueda
- Department of Surgery, Plastic Surgery Division, Cancer Institute of Estado de São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Eduardo Montag
- Department of Surgery, Plastic Surgery Division, Cancer Institute of Estado de São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Alberto Okada
- Department of Surgery, Plastic Surgery Division, Cancer Institute of Estado de São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | - Rolf Gemperli
- Plastic Surgery, University of São Paulo, São Paulo, Brazil
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84
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Seitz AJ, Asaad M, Hanson SE, Butler CE, Largo RD. Autologous Fat Grafting for Oncologic Patients: A Literature Review. Aesthet Surg J 2021; 41:S61-S68. [PMID: 34002764 DOI: 10.1093/asj/sjab126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Autologous fat grafting (AFG) serves as an effective method to address volume defects, contour irregularities, and asymmetry in both aesthetic and reconstructive procedures. In recent years, there has been growing concern about the potential of cancer recurrence and interference with cancer surveillance in oncologic patients receiving AFG. The adipose tissue contains adipose-derived stem cells (ASCs), a specific type of mesenchymal stem cells, that facilitate secretion of numerous growth factors which in turn stimulate tissue regeneration and angiogenesis. As such, it has been theorized that ASCs may also have the potential to stimulate cancer cell proliferation and growth when used in oncologic patients. Multiple research studies have demonstrated the ability of ACSs to facilitate tumor proliferation in animal models. However, clinical research in oncologic patients has yielded contradictory findings. Although the literature pertaining to oncologic safety in head and neck, as well as sarcoma, cancer patients remains limited, studies demonstrate no increased risk of tumor recurrence in these patient populations receiving AFG. Similarly, both the efficacy and safety of AFG have been well established in breast cancer patients through numerous clinical studies. More recently, preclinical research in animal models has shown that AFG has the potential to facilitate tissue regeneration and improve joint contracture following irradiation. Ultimately, further research is needed to elucidate the safety of AFG in a variety of oncologic patients, as well as explore its use in tissue regeneration, particularly in the setting of radiotherapy. Level of Evidence: 4.
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Affiliation(s)
- Allison J Seitz
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Malke Asaad
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Summer E Hanson
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Charles E Butler
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rene D Largo
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
Autologous fat grafting in the setting of breast augmentation and reconstruction has become globally accepted and routinely performed. There is general consensus that small-volume grafting is reproducible and predictable; however, large-volume fat grafting (>100 mL) is less predictable and is not as commonly performed. The aim of this article was to review outcomes following large-volume and megavolume fat grafting in the setting of breast augmentation and reconstruction. Level of Evidence: 4.
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86
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Oncologic Safety of Autologous Fat Grafting after Breast Cancer Surgical Treatment: A Matched Cohort Study. Plast Reconstr Surg 2021; 148:11-20. [PMID: 34003814 DOI: 10.1097/prs.0000000000008037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Autologous fat grafting has been an increasingly popular procedure for remodeling the breast of patients undergoing breast cancer surgery. This study's objective was to investigate whether autologous fat grafting is associated with a higher risk of disease recurrence in the context of late breast reconstruction for patients diagnosed with breast cancer who have undergone either breast-conserving surgery or mastectomy. METHODS A retrospective matched cohort study was performed in a single tertiary health care center. Data were collected from 42 patients formerly treated for breast cancer who underwent the first session of autologous fat grafting between August of 2007 and June of 2016. A total of 126 patients with similar features, who did not undergo autologous fat grafting, were individually matched at a 1:3 ratio with the autologous fat grafting group. The primary endpoint was locoregional recurrence. Secondary outcomes were rates of local and distant recurrences, disease-free survival, and overall survival. RESULTS At a mean follow-up of 65 months after fat grafting, no significant differences were found between the lipofilling and control groups for locoregional recurrence (7.1 percent versus 6.3 percent; p = 0.856), local recurrence (7.1 percent versus 5.6 percent; p = 0.705), distant recurrence (14.3 percent versus 7.9 percent; p = 0.238), disease-free survival (21.4 percent versus 19.0 percent; p = 0.837), and overall survival (14.3 percent versus 7.1 percent; p = 0.181). CONCLUSIONS No evidence of increased risk in any of the survival outcomes was identified. Lipofilling seems to be a safe procedure for breast reconstruction after surgical treatment of breast cancer. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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87
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Overcoming functional challenges in autologous and engineered fat grafting trends. Trends Biotechnol 2021; 40:77-92. [PMID: 34016480 DOI: 10.1016/j.tibtech.2021.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
Autologous fat grafting offers significant promise for the repair of soft tissue deformities; however, high resorption rates indicate that engineered solutions are required to improve adipose tissue (AT) survival. Advances in material development and biofabrication have laid the foundation for the generation of functional AT constructs; however, a balance needs to be struck between clinically feasible delivery and improved structural integrity of the grafts. A new approach combining the objectives from both the clinical and research communities will assist in developing morphologically and genetically mature AT constructs, with controlled spatial arrangement and increased potential for neovascularization. In a rapidly progressing field, this review addresses research in both the preclinical and bioengineering domains and assesses their ability to resolve functional challenges.
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88
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Wang C, Wang X, Huang J, Yu N, Long X. Severe fat embolism after autologous fat grafting in vaginal tightening and breast augmentation surgery. J Int Med Res 2021; 48:300060520949109. [PMID: 32811245 PMCID: PMC7441288 DOI: 10.1177/0300060520949109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Autologous fat grafting has become increasingly popular in the field of aesthetic surgery because of its biocompatibility and low donor site morbidity. However, some fatal complications may occur following the surgery. We herein describe a woman who developed severe fat embolism after autologous fat grafting for vaginal tightening and breast augmentation surgery. The patient developed symptoms of dyspnea and hypoxemia. Computed tomography pulmonary angiography showed multiple filling defects in the bilateral pulmonary arteries and branches with a maximum size of approximately 1.2 × 0.7 cm. Fat embolism was assumed to have occurred by injection of fat directly into the vessels around the vagina. Further research is needed to elucidate the anatomical mechanism underlying this phenomenon.
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Affiliation(s)
- Chenyu Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Piccotti F, Rybinska I, Scoccia E, Morasso C, Ricciardi A, Signati L, Triulzi T, Corsi F, Truffi M. Lipofilling in Breast Oncological Surgery: A Safe Opportunity or Risk for Cancer Recurrence? Int J Mol Sci 2021; 22:ijms22073737. [PMID: 33916703 PMCID: PMC8038405 DOI: 10.3390/ijms22073737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Lipofilling (LF) is a largely employed technique in reconstructive and esthetic breast surgery. Over the years, it has demonstrated to be extremely useful for treatment of soft tissue defects after demolitive or conservative breast cancer surgery and different procedures have been developed to improve the survival of transplanted fat graft. The regenerative potential of LF is attributed to the multipotent stem cells found in large quantity in adipose tissue. However, a growing body of pre-clinical evidence shows that adipocytes and adipose-derived stromal cells may have pro-tumorigenic potential. Despite no clear indication from clinical studies has demonstrated an increased risk of cancer recurrence upon LF, these observations challenge the oncologic safety of the procedure. This review aims to provide an updated overview of both the clinical and the pre-clinical indications to the suitability and safety of LF in breast oncological surgery. Cellular and molecular players in the crosstalk between adipose tissue and cancer are described, and heterogeneous contradictory results are discussed, highlighting that important issues still remain to be solved to get a clear understanding of LF safety in breast cancer patients.
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Affiliation(s)
- Francesca Piccotti
- Laboratorio di Nanomedicina ed Imaging Molecolare, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (F.P.); (C.M.); (A.R.)
| | - Ilona Rybinska
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (I.R.); (T.T.)
| | - Elisabetta Scoccia
- Breast Unit, Surgery Department, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (E.S.); (F.C.)
| | - Carlo Morasso
- Laboratorio di Nanomedicina ed Imaging Molecolare, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (F.P.); (C.M.); (A.R.)
| | - Alessandra Ricciardi
- Laboratorio di Nanomedicina ed Imaging Molecolare, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (F.P.); (C.M.); (A.R.)
| | - Lorena Signati
- Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”, Università Degli Studi di Milano, 20157 Milano, Italy;
| | - Tiziana Triulzi
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (I.R.); (T.T.)
| | - Fabio Corsi
- Breast Unit, Surgery Department, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (E.S.); (F.C.)
- Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”, Università Degli Studi di Milano, 20157 Milano, Italy;
| | - Marta Truffi
- Laboratorio di Nanomedicina ed Imaging Molecolare, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (F.P.); (C.M.); (A.R.)
- Correspondence: ; Tel.: +39-0382-592219
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90
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Lauvrud AT, Gümüscü R, Wiberg R, Brohlin M, Kelk P, Wiberg M, Kingham PJ. Water jet-assisted lipoaspiration and Sepax cell separation system for the isolation of adipose stem cells with high adipogenic potential. J Plast Reconstr Aesthet Surg 2021; 74:2759-2767. [PMID: 33994109 DOI: 10.1016/j.bjps.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Water jet-assisted liposuction has gained popularity due to favourable fat grafting outcomes. In this study, we compared stem cells obtained from fat isolated with manual or the water jet-assisted procedure. METHODS Liposuction of abdominal fat was performed using the two methods on each donor (n = 10). Aspirate samples were collagenase digested and the isolated cells seeded in vitro prior to proliferation, adipogenic differentiation and angiogenic activity analyses. RESULTS Cells from either procedure proliferated at similar rates and exhibited a similar colony-forming ability. The cells expressed stem cell markers CD73, CD90 and CD105. In the water jet cell preparations, there were higher numbers of cells expressing CD146. Robust adipogenic differentiation was observed in cultures expanded from both manual and water jet lipoaspirates. Gene analysis showed higher expression of the adipocyte markers aP2 and GLUT4 in the adipocyte-differentiated water jet cell preparations, and ELISA indicated increased secretion of adiponectin from these cells. Both cell groups expressed vasculogenic factors and the water jet cells promoted the highest levels of in vitro angiogenesis. Given these positive results, we further characterised the water jet cells when prepared using an automated closed cell processing unit, the Sepax-2 system (Cytiva). The growth and stem cell properties of the Sepax-processed cells were similar to the standard centrifugation protocol, but there was evidence for greater adipogenic differentiation in the Sepax-processed cells. CONCLUSIONS Water jet lipoaspirates yield cells with high adipogenic potential and angiogenic activity, which may be beneficial for use in cell-assisted lipotransfers.
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Affiliation(s)
- Anne Therese Lauvrud
- Department of Integrative Medical Biology, Umeå University, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå 907 37, Sweden.
| | - Rojda Gümüscü
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå 907 37, Sweden
| | - Rebecca Wiberg
- Department of Integrative Medical Biology, Umeå University, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå 907 37, Sweden
| | - Maria Brohlin
- Department of Clinical Microbiology, Infection and Immunity, Umeå University, Sweden
| | - Peyman Kelk
- Department of Integrative Medical Biology, Umeå University, Sweden
| | - Mikael Wiberg
- Department of Integrative Medical Biology, Umeå University, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå 907 37, Sweden
| | - Paul J Kingham
- Department of Integrative Medical Biology, Umeå University, Sweden
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91
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Banani MA, Rahmatullah M, Farhan N, Hancox Z, Yousaf S, Arabpour Z, Moghaddam ZS, Mozafari M, Sefat F. Adipose tissue-derived mesenchymal stem cells for breast tissue regeneration. Regen Med 2021; 16:47-70. [PMID: 33533667 DOI: 10.2217/rme-2020-0045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
With an escalating incidence of breast cancer cases all over the world and the deleterious psychological impact that mastectomy has on patients along with several limitations of the currently applied modalities, it's plausible to seek unconventional approaches to encounter such a burgeoning issue. Breast tissue engineering may allow that chance via providing more personalized solutions which are able to regenerate, mimicking natural tissues also facing the witnessed limitations. This review is dedicated to explore the utilization of adipose tissue-derived mesenchymal stem cells for breast tissue regeneration among postmastectomy cases focusing on biomaterials and cellular aspects in terms of harvesting, isolation, differentiation and new tissue formation as well as scaffolds types, properties, material-host interaction and an in vitro breast tissue modeling.
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Affiliation(s)
- Mohammed A Banani
- Division of Surgery & Interventional Science, University College London, London, NW3 2PS, UK
| | - Mohammed Rahmatullah
- Division of Surgery & Interventional Science, University College London, London, NW3 2PS, UK
| | - Nawras Farhan
- Division of Surgery & Interventional Science, University College London, London, NW3 2PS, UK
| | - Zoe Hancox
- Department of Biomedical & Electronics Engineering, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK
| | - Safiyya Yousaf
- Department of Biomedical & Electronics Engineering, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK
| | - Zohreh Arabpour
- Department of Biomedical & Electronics Engineering, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK
| | - Zoha Salehi Moghaddam
- Department of Biomedical & Electronics Engineering, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK.,Interdisciplinary Research Centre in Polymer Science & Technology (IRC Polymer), University of Bradford, Bradford, BD7 1DP, UK
| | - Masoud Mozafari
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, Canada
| | - Farshid Sefat
- Department of Biomedical & Electronics Engineering, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK.,Interdisciplinary Research Centre in Polymer Science & Technology (IRC Polymer), University of Bradford, Bradford, BD7 1DP, UK
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92
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Auclair E, Gianfermi M. Evaluation of a new adipose tissue processing method for breast and buttock fat grafting procedures. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Background
There is still some debate about the best adipose processing method for autologous fat transfer procedures. This article reports a series of 66 fat grafting procedures using a novel fat processing technique that involves washing, “micronization,” and decantation.
Methods
We retrospectively reviewed the files of all patients operated on over a 2-year period by the two investigators. They underwent breast or buttock surgery that employed the novel fat processing technique for fat transfer. Complications and patient satisfaction were recorded, and fat resorption was qualitatively assessed based on clinical examination and photographs.
Results
Data were retrieved from a total of 66 procedures performed on 43 patients: 17 breast augmentations, 8 buttock augmentations, and 41 breast reconstructions. Five patients also underwent concomitant facial fat grafting. The complications were one case of transient liponecrotic cyst in the breast, one case of transient areolar sensitivity reduction, and two cases of infection. The infections were reported in patients from the breast reconstruction cohort who had a history of radiotherapy. There was no complication associated with facial fat grafting. Patient satisfaction was achieved in 82.4 to 92.5% of cases depending on the study cohort. Fat resorption was graded as minimal to moderate in 95% of all cases.
Conclusions
This retrospective study supports the safety and effectiveness of this novel fat processing method in breast and buttock surgeries. Further controlled studies are needed to compare its performance with that of other techniques.
Level of evidence: Level III, therapeutic study
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93
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Wang K, Mu D, Zhang X, Lin Y. Lactation History Affects Postoperative Fat Volume Retention Rate in Autologous Fat Grafting Breast Augmentation. Aesthetic Plast Surg 2021; 45:118-126. [PMID: 32215697 DOI: 10.1007/s00266-020-01683-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autologous fat grafting has been widely used in the field of plastic surgery, especially breast aesthetic augmentation. However, postoperative fat volume retention rate is still difficult to predict. OBJECTIVE The authors conducted a retrospective study to compare the fat volume retention rate in patients with varying lactation histories. METHODS A retrospective study was performed of patients who underwent autologous fat grafting breast augmentation in our center from 2012 to 2018. Individuals were separated into two groups according to their lactation history: Group A without a history of lactation and Group B with a history of lactation. RESULTS A total of 70 cases (137 breasts) were included (Group A, n = 40; Group B, n = 30). Patients without lactation history were younger (Group A, 25.88 years; Group B, 36.03 years, p < 0.05) and had a significantly lower mean body mass index (Group A,19.72 kg/m2; Group B, 20.83 kg/m2, p = 0.010). The proportion of donor sites varied (Group A, abdomen 25%, thigh 70%; Group B, abdomen 53.33%, thigh 46.67%, p < 0.05). The percentage of tissue volume retained of patients with a history of lactation was significantly higher (Group A, 30.42%; Group B, 41.03%, p = 0.028). CONCLUSION Significant differences in postoperative volume retention rate in different patients based on lactation history were observed. The volume retention rate after breast augmentation with autologous fat is higher in patients with a history of lactation. The physiological process of lactation may influence the response to autologous fat grafting, but further studies of the mechanism are needed. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Keke Wang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Dali Mu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China.
| | - Xiaoyu Zhang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Yan Lin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
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94
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Treatment of knee osteoarthritis by intra-articular injection of concentrated autologous adipose tissue: a twenty four month follow-up study. INTERNATIONAL ORTHOPAEDICS 2021; 45:627-633. [PMID: 33394073 DOI: 10.1007/s00264-020-04923-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of autologous concentrated adipose tissue for the treatment of knee OA. METHODS Eighty-seven patients with knee arthritis from grade 1 to 3, according to Kellgren-Lawrence scale, have been treated with knee arthroscopy and successive intra-articular injection of concentrated adipose tissue. The efficacy of the treatment has been evaluated by the Knee Society Score, Lysholm Score, Forgotten Joint Score, Knee Injury and Osteoarthritis Outcome Score and Noise Reporting Scale. RESULTS A total of 78/87 patients concluded the study. Overall, the patients were satisfied with the intervention and a significant reduction of the pain was observed in 67 patients, while the others did not report any change in pain severity or worsening. A statistically significant improvement was observed in the considered orthopaedic index, and no major adverse effects were described. The first week after the intervention, most patients reported knee swelling. Five patients failed because they underwent knee replacement surgery between five and nine months from treatment. CONCLUSIONS In patients with knee OA, a single intra-articular injection of autologous adipose tissue reduced knee pain, stiffness, improved knee function and quality of life without severe complications.
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95
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Sabbatini M, Faruggio S, Verna G, Magnelli V, Dondero F, Boldorini R, Cannas M, Grossini E. Processing Adipose Tissue to Make it More Stable When Used for Refilling: A Morphologic and Immunohistochemistry Evaluation. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211061030. [PMID: 34894844 PMCID: PMC8679401 DOI: 10.1177/00469580211061030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Breast reconstruction has gained from lipofilling the possibility to recover the aesthetic outcome of anatomical profile in a more natural appearance. However, until today, the long-term graft survival remains unpredictable, and sometimes it does not guarantee a well-adequate aesthetic result. In the present work, the morphological changes, occurring in fat mass used for refilling, harvested by the Coleman's procedure or through the washing/fragmenting procedure were analysed. Adipocyte size; immunohistochemistry against CD8, CD31, CD68 and M2-type macrophages and catalase enzyme, were analysed in vitro on fat mass cultured for 4 weeks. Our observation reveals an increase of connective tissue around the mass and a high number of immune cells occurrence in fat mass harvested by the Coleman's procedure. Instead, the washing/fragmented procedure would reduce the number of immune cells within the fat mass, increase the size of adipocytes, and cause a wider presence of active vessels profile and greater catalase expression. We hypothesize that the fat mass processed by the Coleman's procedure would remain more reactive due to a higher number of immune and macrophages cells, prone to develop cystic formation, leading to a suboptimal integration in the recipient site. On the other hand, the conditions more prone to realize an optimal integration would occur in the fat mass processed by the washing/fragmenting procedure: a reduced number of immune cells, low amount of connective tissue, presence of larger adipocytes. Follow-up monitoring did support our conclusion, as we observed a reduction of re-intervention for refilling procedure in patients treated with the washing/fragmenting procedure.
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Affiliation(s)
- Maurizio Sabbatini
- Department of Science and
Technology Innovation, UPO University, Alessandria, Italy
| | - Serena Faruggio
- Department of Translational
Medicine, UPO University, Novara, Italy
| | - Giovanni Verna
- Department of Plastic and
Reconstructive Surgery, Hospital “Maggiore Della
Carità,” Novara, Italy
| | - Valeria Magnelli
- Department of Science and
Technology Innovation, UPO University, Alessandria, Italy
| | - Francesco Dondero
- Department of Science and
Technology Innovation, UPO University, Alessandria, Italy
| | - Renzo Boldorini
- Department of Health Science,
Section of Pathological Anatomy, UPO University, Novara, Italy
| | - Mario Cannas
- Department of Health Sciences, UPO University, Novara, Italy
| | - Elena Grossini
- Department of Translational
Medicine, UPO University, Novara, Italy
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96
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Bayat M, Bahrami N, Mesgari H. Rhinoplasty with Fillers and Fat Grafting. Oral Maxillofac Surg Clin North Am 2020; 33:83-110. [PMID: 33246548 DOI: 10.1016/j.coms.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nonsurgical rhinoplasty is one choice for cases in which open surgery may be harmful, the deformity is not indicated to correct with open surgery, or in patients who have phobia of general anesthesia or any type of surgery. Autologous fat injection or fillers are most common materials currently available in the market. In this article, we explain the indications, contraindications, methods, and complications of this treatment.
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Affiliation(s)
- Mohammad Bayat
- Department of Oral & Maxillofacial Surgery, Shariati Hospital, Tehran University of Medical Sciences, north kargar ave, Tehran Iran.
| | - Naghmeh Bahrami
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, north kargar ave, Tehran Iran; Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Mesgari
- Facial Esthetic Surgery, Tehran University of Medical Sciences, north kargar ave, Tehran Iran
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97
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Morioka E, Noguchi M, Noguchi M, Inokuchi M, Shimada KI, Shioya A, Aikawa A, Minato H, Earashi M. A case of recurrent malignant phyllodes tumor undergoing nipple-sparing mastectomy with immediate breast reconstruction. Surg Case Rep 2020; 6:297. [PMID: 33237380 PMCID: PMC7688876 DOI: 10.1186/s40792-020-01022-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022] Open
Abstract
Background Although the primary treatment for malignant phyllodes tumor (PT) is complete surgical excision with either breast-conserving surgery or total mastectomy, recent technical advances have led to the adoption of nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR). Case presentation A 28-year-old woman noticed a mass in her left breast that was rapidly increasing in size. She underwent tumor excision and a histological diagnosis of marked degenerative and necrotic induration suggested benign PT. One year later, however, she was found to have recurrent masses in the left breast on follow-up mammography and sonography. Needle biopsy was performed and the tumor was diagnosed as borderline or malignant PT. She underwent NSM and sentinel lymph-node biopsy with IBR using a tissue expander. Histological examination of the mastectomy specimen showed multiple fibroepithelial tumors with marked stromal overgrowth, focal necrosis, and hemorrhage. Stromal cells showed pleomorphism and a maximal mitotic rate of approximately 25 per 10 high-power fields. The tumor was diagnosed as malignant PT. She did not receive adjuvant chemotherapy or radiation treatment. At 3-year follow-up, the patient remains free of disease and highly satisfied with the cosmetic results. Conclusions NSM with IBR is not a contraindication for malignant PT. It is both curative and can offer an appealing cosmetic option for localized malignant PT.
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Affiliation(s)
- Emi Morioka
- Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Masakuni Noguchi
- Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan.
| | - Miki Noguchi
- Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Masafumi Inokuchi
- Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Ken-Ichi Shimada
- Department of Plastic Surgery, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Akane Aikawa
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Hiroshi Minato
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Mitsuharu Earashi
- Department of Breast Surgery, Toyama Nishi General Hospital, 1019, Shimokutsuwada, Fuchu-machi, Toyama-shi, Toyama, 939-2716, Japan
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98
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Wang K, Mu D, Zhang X, Lin Y. Is Volume Retention of the Breast Affected by Menstrual Cycle Phase at the Time of Autologous Fat Grafting? Aesthet Surg J 2020; 40:1301-1308. [PMID: 31930298 DOI: 10.1093/asj/sjaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Autologous fat grafts are commonly employed in plastic surgery, especially for aesthetic breast augmentation. However, it is difficult to predict the postoperative fat volume retention rate. OBJECTIVES The authors conducted a retrospective study comparing the fat volume retention rates of breast lipoaugmentation performed during different phases of the menstrual cycle. METHODS The study included patients who underwent autologous fat grafting (AFG) breast augmentation from January 2012 to December 2018. Forty-eight individuals (94 breasts) were separated into 3 groups according to their menstrual stage: Group A: 10 patients (18 breasts); follicular group (end of menstruation to approximately 10 days); Group B: 15 patients (30 breasts); ovulatory group (11-17 days); Group C: 23 patients (46 breasts); luteal group (approximately 18 days to the next menstrual cramps). RESULTS Mean age, menarche age, menstrual cycle, menstruation, and body mass index were comparable among the groups (P > 0.05). Patients with a history of lactation were comparable among the groups (Group A, 50%; Group B, 53.33%; Group C, 43.48%, P > 0.05). The overall volume retention rate of patients who underwent AFG during ovulation was significantly higher (Group A, 26.94%; Group B, 49.06%, Group C, 35.73%, P = 0.023), with no significant difference in volume retention rates between the follicular and luteal phases (P > 0.05). CONCLUSIONS Fat volume retention rates were higher when AFG breast augmentation was performed during ovulation, providing a new direction to improve long-term retention rates of autologous fat grafts. However, due to the small sample size, incomplete medical records, and lack of test data, further research is needed. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Keke Wang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Dali Mu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Xiaoyu Zhang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yan Lin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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99
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Patel AA, Martin SA, Cheesborough JE, Lee GK, Nazerali RS. The safety and efficacy of autologous fat grafting during second stage breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:792-799. [PMID: 33189618 DOI: 10.1016/j.bjps.2020.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/30/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients often pursue revisions following implant-based breast reconstruction (IBR) to achieve their desired result. Fat grafting is a popular choice for patients and can be performed at second stage reconstruction or at a future date as a revisionary surgery. We investigate the best time to fat graft in IBR by comparing the outcomes of patients who received fat grafting during implant placement with those who pursued fat grafting during a tertiary procedure. METHODS We retrospectively reviewed the charts of 157 patients (270 breasts) who underwent immediate two-stage IBR and fat grafting over a five-year period (2012-2016) at our institution. Two cohorts were created based on timing of first fat grafting procedure: immediate (IFG) and delayed (DFG). Charts were reviewed for postoperative complications or revisions. RESULTS Complication rates were lower when fat grafting was performed during the second stage (p = 0.0331). Patients in the DFG cohort required more than one additional revision (p < 0.001) until the completion of reconstruction. Patients in the IFG cohort completed their reconstruction and revisions more than one year earlier than the DFG cohort (p < 0.001). Multivariable regressions showed IFG to be associated with decreased revisions (p < 0.001) and total fat grafting procedures (p = 0.008). CONCLUSIONS These results indicate that fat grafting at the second stage does not increase overall complication rates, require fewer additional surgeries, and enables patients to reach their desired aesthetic appearance in a shorter time frame. Fewer total surgeries translate not only to a more economical option but also obviate the risk of complications that come with additional surgeries.
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Affiliation(s)
- Ashraf A Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd, Suite 400, Stanford, CA 94305, United States; College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Shanique A Martin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd, Suite 400, Stanford, CA 94305, United States
| | - Jennifer E Cheesborough
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd, Suite 400, Stanford, CA 94305, United States
| | - Gordon K Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd, Suite 400, Stanford, CA 94305, United States
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, 770 Welch Rd, Suite 400, Stanford, CA 94305, United States.
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100
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Taminato M, Tomita K, Nomori M, Maeda D, Seike S, Tashima H, Yano K, Kubo T. Fat-augmented latissimus dorsi myocutaneous flap for total breast reconstruction: A report of 54 consecutive Asian cases. J Plast Reconstr Aesthet Surg 2020; 74:1213-1222. [PMID: 33257301 DOI: 10.1016/j.bjps.2020.10.089] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022]
Abstract
Immediate fat grafting to the latissimus dorsi myocutaneous (LD) flaps is a breakthrough that addresses the issue of insufficient volume of LD. However, the use of this procedure in Asian patients has not yet been reported. Retrospective chart reviews were conducted on 54 Japanese cases of total breast reconstruction using fat-augmented LD flaps at our hospital from September 2017 to June 2019. There were 24 immediate reconstruction cases, 18 immediate two-stage reconstruction cases, nine delayed reconstruction cases, and three delayed two-stage reconstruction cases. Median age was 46 years (range, 29-69 years), and median body mass index was 21.5 (17-33.8). Median mastectomy specimen and flap weight was 225 g (123-993) and 225 g (130-796), respectively. The median volume of fat graft was 114 ml (46-305) for the LD flap and 58 ml (15-200) for the pectoralis major muscle. Of the 53 completed reconstruction cases, 38 (71.7%) achieved sufficient volume with the initial operation and six (11.3%) required additional fat grafting. The proportion of cases in the immediate reconstruction group, which achieved sufficient volume in the initial operation was significantly higher than those of the other three reconstruction groups (p = 0.007). Total breast reconstruction with fat-augmented LD flaps is a viable procedure for thin patients who have insufficient abdominal tissue, for those who wish to avoid abdominal scars, and for those in whom abdominal flaps have already been used. The procedure allows for large volume transplantation even with small skin paddles, which allows for smaller skin paddles to be designed without the need for extensive subcutaneous dissection.
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Affiliation(s)
- Mifue Taminato
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | - Koichi Tomita
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan.
| | - Michiko Nomori
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | - Daisuke Maeda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | - Shien Seike
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | - Hiroki Tashima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | | | - Tateki Kubo
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
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