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Bayti T, Panouilleres M, Tropet Y, Bonnetain F, Pauchot J. Lipofilling en reconstruction mammaire. Étude rétrospective de la satisfaction et de la qualité de vie à propos de 68 patientes. ANN CHIR PLAST ESTH 2016; 61:190-9. [DOI: 10.1016/j.anplas.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/13/2015] [Indexed: 11/28/2022]
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Potential Safety Loophole of Fat Grafting in Breast Cancer Patients. Aesthetic Plast Surg 2016; 40:380-6. [PMID: 27071383 DOI: 10.1007/s00266-016-0634-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/16/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED Autologous fat grafting (AFG) accounts for 9.1 % of all cosmetic surgical procedures in the world. Its use has been increasing tremendously in breast reconstruction and produces satisfying outcomes. However, the lack of standard guidelines for routine screening protocols in breast cancer patients before and after AFG warrants consideration of the safety of AFG use in post-mastectomy and post-lumpectomy reconstruction. This manuscript examines AFG in breast reconstruction publications and details the complications, the mechanism of AFG, as well as the relationship between adipose stem cells (ASCs) and cancer recurrence. The ASCs transferred in AFG act as multiple potent stem cells, which can impact cancer recurrence in various ways. Both in vitro and in vivo studies show that ASCs can stimulate the recurrence of breast cancer. Based on a review of existing evidence, we provide recommendations and guidelines for AFG use in breast reconstruction to aid in clinical decision-making. Further investigations are needed to evaluate the long-term clinical safety of AFG as well as the proposed guidelines. NO LEVEL ASSIGNED 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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Fat grafting for breast cancer patients: From basic science to clinical studies. Eur J Surg Oncol 2016; 42:1088-102. [PMID: 27265042 DOI: 10.1016/j.ejso.2016.04.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/08/2016] [Indexed: 02/06/2023] Open
Abstract
Fat grafting in the surgical treatment of breast cancer has become popular in a short period of time because of the rising expectations of good esthetic results by the patients as well as the simplicity of the technique; however, the oncological safety for breast cancer patients remains a matter of debate. The procedure raises many questions considering that recent in-vitro studies have shown that fat grafting could promote tumor recurrence through diverse mechanisms, or even facilitate distant metastasis. We present a review of the currently available experimental and clinical data in order to describe and discuss patient selection criteria following breast cancer surgery.
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Muench DP. Breast Augmentation by Water-Jet Assisted Autologous Fat Grafting: A Report of 300 Operations. Surg J (N Y) 2016; 2:e19-e30. [PMID: 28824986 PMCID: PMC5553464 DOI: 10.1055/s-0036-1584165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/04/2016] [Indexed: 01/26/2023] Open
Abstract
Background
The BEAULI -method (Breast Augmentation by Lipotransfer) is available for extraction and processing of large transplantable fat quantities. The aim of this work is to describe the surgical technique precisely and reproducibly and to provide an overview of the autologous fat transfer based on surgical experience.
Method
The author performed 300 autologous fat transplantations on 254 women between September 3, 2010, and May 13, 2015. Patients desiring moderate volume increase, fuller and firmer breasts, as well as an optimization of the silhouette, ideally with the concurrent desire of the correction of unwanted fat deposits, were selected. The fat was extracted via water-jet assisted liposuction (Body-jet, Human Med AG, Schwerin, Germany), and the fat cells were subsequently separated with the Lipocollector
®
(Human Med AG, Schwerin, Germany).
Results
The results were assessed with a control exam and photo comparison and were based on the responses on a questionnaire. Overall, 35.9% of the patients defined the result as very good, 38.6% as good, 22.4% as satisfactory, and 3.1% as poor.
Conclusion
This study shows that the autologous fat cell transplantation into the female breast via water-jet assisted liposuction achieves a moderate and harmoniously appearing breast volume enlargement as well as contour improvement. Further studies with more cases and longer observation periods over several years could contribute to improving the method of the autologous fat transfer regarding the grow-in rate, efficiency, and safety.
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Affiliation(s)
- Daniel P Muench
- Practice for Outpatient Surgery, Wiedlisbach/Berne, Switzerland
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Combellack EJ, Jessop ZM, Naderi N, Griffin M, Dobbs T, Ibrahim A, Evans S, Burnell S, Doak SH, Whitaker IS. Adipose regeneration and implications for breast reconstruction: update and the future. Gland Surg 2016; 5:227-41. [PMID: 27047789 PMCID: PMC4791352 DOI: 10.3978/j.issn.2227-684x.2016.01.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/17/2015] [Indexed: 12/20/2022]
Abstract
The evolution of breast reconstruction and management of breast cancer has evolved significantly since the earliest descriptions in the Edwin Smith Papyrus (3,000 BC). The development of surgical and scientific expertise has changed the way that women are managed, and plastic surgeons are now able to offer a wide range of reconstructive options to suit individual needs. Beyond the gold standard autologous flap based reconstructions, regenerative therapies promise the elimination of donor site morbidity whilst providing equivalent aesthetic and functional outcomes. Future research aims to address questions regarding ideal cell source, optimisation of scaffold composition and interaction of de novo adipose tissue in the microenvironment of breast cancer.
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Zhu L, Mohan AT, Vijayasekaran A, Hou C, Sur YJ, Morsy M, Saint-Cyr M. Maximizing the Volume of Latissimus Dorsi Flap in Autologous Breast Reconstruction with Simultaneous Multisite Fat Grafting. Aesthet Surg J 2016; 36:169-78. [PMID: 26546990 DOI: 10.1093/asj/sjv173] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The pedicled latissimus dorsi (LD) flap serves an important function in breast reconstruction, but its utility is limited by its inability to provide sufficient breast volume. OBJECTIVES The purpose of this preliminary report was to review the techniques and outcomes of utilizing fat-grafted, volume-enhanced LD flap transfer with fat grafting recipient sites in autologous breast reconstruction. METHODS A retrospective study was performed of 10 patients (14 breasts) who underwent autologous breast reconstruction utilizing the LD flap transfer technique and simultaneous fat grafting between August 2012 and September 2014. Multilayer, multisite fat grafting was performed to the LD muscle, LD skin paddle, mastectomy skin flaps, and the pectoralis major and serratus muscles simultaneously with the LD flap transfer. RESULTS Three patients underwent an immediate breast reconstruction, four underwent a delayed breast reconstruction, and four underwent a tertiary breast reconstruction following previously failed breast reconstructions (one patient underwent each of the first two procedures, one on each breast). The average age of the patients was 55 years (range, 39-76 years), the average body mass index of the patients was 29.3 (range, 19.6-39.9), and the average fat grafting volume for the patients was 176 mL (range, 50-300 mL). There was 100% flap survival and complete wound healing. No seroma or fat grafting-related complications were clinically detected. Three patients required additional fat grafting. CONCLUSIONS The fat-grafted, volume-enhanced LD flap procedure with fat grafting recipient sites offers a simple and safe technique for autologous breast reconstruction, with low morbidity and fast recovery. It can be a useful alternative to utilizing abdomen-based flaps in autologous breast reconstruction or could be performed to salvage both implant-based and free-flap breast reconstructions. LEVEL OF EVIDENCE 4: Therapeutic.
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Affiliation(s)
- Lin Zhu
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Anita T Mohan
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Aparna Vijayasekaran
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Christine Hou
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Yoo Joon Sur
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Mohamed Morsy
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Michel Saint-Cyr
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
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N. MM. LIPOINYECCIÓN: CONCEPTOS BÁSICOS Y APLICACIÓN CLÍNICA. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mestak O, Hromadkova V, Fajfrova M, Molitor M, Mestak J. Evaluation of Oncological Safety of Fat Grafting After Breast-Conserving Therapy: A Prospective Study. Ann Surg Oncol 2015; 23:776-81. [DOI: 10.1245/s10434-015-4908-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 12/22/2022]
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Petit JY, Maisonneuve P, Rotmensz N, Bertolini F, Clough KB, Sarfati I, Gale KL, Macmillan RD, Rey P, Benyahi D, Rietjens M. Safety of Lipofilling in Patients with Breast Cancer. Clin Plast Surg 2015; 42:339-44, viii. [DOI: 10.1016/j.cps.2015.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pinell-White XA, Etra J, Newell M, Tuscano D, Shin K, Losken A. Radiographic Implications of Fat Grafting to the Reconstructed Breast. Breast J 2015; 21:520-5. [PMID: 26133468 DOI: 10.1111/tbj.12450] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Autologous fat transfer is often used to smooth contour irregularities in the reconstructed breast. A potential concern with this technique is that it results in calcified lesions in the breast that can complicate subsequent cancer surveillance. The purpose of this review was to determine how fat grafting to the reconstructed breast impacts postoperative breast imaging. This is a matched cohort analysis of patients who underwent postmastectomy breast reconstruction with and without fat grafting as a secondary procedure. Nonfat grafted reconstructive patients were matched based on age, year of initial reconstruction, and type of reconstruction. Postoperative imaging at our institution was required for inclusion. The two groups were compared in terms of incidence and distribution of radiographic studies performed in follow-up and the need for biopsies. Fifty-one reconstructed breasts with a history of fat grafting were compared to 51 nonfat grafted, reconstructed breasts. The fat grafted group underwent a total of 204 breast imaging studies over a mean follow-up of 4.2 years, while the nonfat grafted group underwent 167 studies over 4.1 years (p = 0.21). More mammograms, ultrasounds, and magnetic resonance images were performed after fat grafting, but a significant difference was evident only for mammography (34 versus 12, p = 0.05). The incidence of breast biopsy to clarify abnormal imaging was nonsignificantly higher in the fat grafted group (17.6% versus 7.8%, p = 0.14). Fewer than 10 percent of imaging studies in the fat grafted cohort were performed to investigate a clinical or radiographic abnormality occupying the same breast quadrant as prior fat injection. Breast cancer patients treated with fat grafting required more breast imaging and biopsies than their nonfat grafted counterparts, but the areas of suspicion poorly corresponded to the site of prior fat grafting. Multimodal breast reconstruction may drive the additional diagnostic burden and not the fat grafting technique itself.
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Affiliation(s)
| | - Joanna Etra
- Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, Georgia
| | - Mary Newell
- Department of Radiology, Emory University, Atlanta, Georgia
| | - Daymen Tuscano
- Department of Radiology, Emory University, Atlanta, Georgia
| | - Kyungmin Shin
- Department of Radiology, Emory University, Atlanta, Georgia
| | - Albert Losken
- Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, Georgia
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Auclair E, Anavekar N. Combined Use of Implant and Fat Grafting for Breast Augmentation. Clin Plast Surg 2015; 42:307-14, vii. [DOI: 10.1016/j.cps.2015.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ceugnart L, Pasquier D, Jarraya H, Rocourt N, Boulanger T, Bercez H, Bachelle F, Chaveron C, Taieb S. Sein traité. Symptômes et imagerie. IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Progressive fat necrosis after breast augmentation with autologous lipotransfer: a cause of long-lasting high Fever and axillary lymph node enlargement. Aesthetic Plast Surg 2015; 39:386-90. [PMID: 25846899 DOI: 10.1007/s00266-015-0480-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Breast augmentation with autologous fat transfer has been widely practiced. However, this procedure is not exempt from complications even after technique refinement. This article aims to describe a case of long-lasting high fever, axillary node enlargement, and upper extremity dysfunction caused by liponecrosis after breast fat injection. Radiological and histological examination confirmed liponecrosis in bilateral breasts. Aspiration, drainage, and irrigation were performed along with empirical antibiotic treatment. The patient has made a full recovery from the operation. Liponecrosis, one of the complications after autologous fat grafting to the breast, may present widely different symptoms and signs. Even experienced surgeons should not underestimate it and caution should be used to maintain safety during and after the procedure. LEVEL OF EVIDENCE V 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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Voglimacci M, Garrido I, Mojallal A, Vaysse C, Bertheuil N, Michot A, Chavoin JP, Grolleau JL, Chaput B. Autologous fat grafting for cosmetic breast augmentation: a systematic review. Aesthet Surg J 2015; 35:378-93. [PMID: 25908697 DOI: 10.1093/asj/sjv030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Breast augmentation is one of the most popular aesthetic surgical procedures. The only potential alternative is autologous fat grafting (AFG), which is not new in principle. This procedure has been used on native breasts since 2009, following the recommendations of some learned societies. OBJECTIVES We performed a systematic review to determine the current worldwide status of fat grafting for aesthetic breast augmentation. METHODS A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria was conducted using the PubMed, EmBASE, and Cochrane library databases. This protocol was registered at the National Institute for Health Research, Prospective Register of Systematic Reviews. RESULTS A total of 42 articles published between 1987 and July 2014 were included. Most of the studies had a low level of evidence, with only one level 2 study, published by Spear (2014), a prospective cohort study which included 10 patients. The publications were from North America, Europe, and Asia. The indications were aesthetic augmentation (92.4%) and congenital malformation (7.6%). Two cases of cancer were reported among the 2023 patients included (0.09%), with a mean follow-up of 22 months, although the follow-up was insufficient for medium- and long-term cancer diagnoses. CONCLUSIONS AFG seems to be a major tool in this field, but we must remain cautious about its systematization for this indication. Preoperative patient selection is essential but underreported. AFG appears particularly relevant in breast malformations. We believe that this method should be practiced within the scope of a national or international registry with proper follow-up of patients.
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Affiliation(s)
- Marie Voglimacci
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Ignacio Garrido
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Ali Mojallal
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Charlotte Vaysse
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Nicolas Bertheuil
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Audrey Michot
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Jean Pierre Chavoin
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Jean Louis Grolleau
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Benoit Chaput
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
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Abstract
Autologous fat grafting is an exciting part of plastic and reconstructive surgery. Fat serves as a filler and its role in tissue regeneration will likely play a more important role in our specialty. As we learn more about the basic science of fat grafting and the standardized techniques and instruments used for fat grafting, this procedure alone or in conjunction with invasive procedures may be able to replace many operations that we perform currently. Its minimally invasive nature will benefit greatly our cosmetic and reconstructive patients, and may even achieve better clinical outcomes.
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Affiliation(s)
- Lee L Q Pu
- Division of Plastic Surgery, University of California, Davis, 2221 Stockton Boulevard, Suite 2123, Sacramento, CA 95817, USA.
| | - Kotaro Yoshimura
- Department of Plastic Surgery, School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Sydney R Coleman
- Department of Plastic Surgery, New York University Langone Medical Center, New York, NY, USA
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Simorre M, Chaput B, Voglimacci Stephanopoli M, Garrido I, Soule-Tholy M, Leguevaque P, Vaysse C. [Lipofilling in breast reconstruction: is there any population with higher risk of local recurrence? Literature systematic review]. ACTA ACUST UNITED AC 2015; 43:309-18. [PMID: 25813431 DOI: 10.1016/j.gyobfe.2015.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/18/2015] [Indexed: 12/13/2022]
Abstract
Safety of the autologous fat grafting (AFG) in the breast parenchyma remains a debated topic, particularly in reconstruction following breast cancer. This procedure still raises many questions, especially considering recent in vitro studies warning about the fact that lipofilling could promote tumor recurrence through increased neoangiogenesis, or facilitate metastasis. Through a systematic literature review on oncological risk and radiological follow-up, conducted from January 2010 to August 2014, we tried to identify populations at risk of recurrence after AFG. The study selection process was adapted from the Prisma statement. Out of the seven analysed patients cohorts, i.e. approximately 1500 AFG procedures, results on the risk of local recurrence appear reassuring after an average follow-up of 42 months. These results should be cautiously interpreted because of the heterogeneity of the studies. However, recurrences have been analysed based on the characteristics of the original tumor and many of them warn about population that seem more at risk of recurrence. Studies on radiological modifications after AFG emphasize the need for the radiologists to know the importance of radiological images induced by this procedure, however, AFG does not seem to interfere with radiological screening of local recurrence. In order to deliver clear information to patients receiving breast reconstruction by lipofilling, prospective studies focused on populations that seem to be most at risk of recurrence are required.
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Affiliation(s)
- M Simorre
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France.
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - M Voglimacci Stephanopoli
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - I Garrido
- Service de chirurgie plastique, reconstructrice et esthétique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - M Soule-Tholy
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - P Leguevaque
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - C Vaysse
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
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69
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Margolis NE, Morley C, Lotfi P, Shaylor SD, Palestrant S, Moy L, Melsaether AN. Update on imaging of the postsurgical breast. Radiographics 2015; 34:642-60. [PMID: 24819786 DOI: 10.1148/rg.343135059] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery.
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Affiliation(s)
- Nathaniel E Margolis
- From the Department of Radiology, Breast Imaging Section, New York University School of Medicine, Langone Medical Center, 550 First Ave, New York, NY 10016
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70
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Kim DH, Kim KS. A Case of Liponecrotic Pseudocyst after Breast Augmentation by Autologous Fat Injection. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2015. [DOI: 10.14730/aaps.2015.21.3.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dae Hyun Kim
- Department of Plastic and Reconstructive Surgery, Myong-Ji Hospital, Goyang, Korea
| | - Kyung Sik Kim
- Department of Plastic and Reconstructive Surgery, Myong-Ji Hospital, Goyang, Korea
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71
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Park SY, Han BK, Cho EY, Bang SI. Chest Wall Lipogranuloma after Hydrogel Implant Rupture: Case Report. ACTA ACUST UNITED AC 2015. [DOI: 10.13104/imri.2015.19.3.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- So Yoon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sa-Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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72
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Daye D, Conant E. Digital breast tomosynthesis findings after surgical lipomodeling in a breast cancer survivor. J Radiol Case Rep 2014; 8:9-15. [PMID: 25426245 DOI: 10.3941/jrcr.v8i9.1532] [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] [Indexed: 11/15/2022] Open
Abstract
Autologous fat grafting or lipomodeling is a newly-adopted technique that is gaining increasing popularity in the treatment of contour deformities following breast conservation therapy. Here, we describe the case of a 47-year-old woman with a prior history of breast cancer treated with a lumpectomy and radiation therapy. She underwent lipomodeling not only of her treated breast but also of the contralateral breast. She presented for her annual mammogram which was performed with digital breast tomosynthesis. On imaging, a space-occupying lesion of mixed density was seen, expanding the lumpectomy site. There was also subtle distortion in the contralateral, non-treated breast. This case aims to highlight the mammographic and tomosynthesis findings seen following lipomodeling that may present diagnostic challenges in this patient population.
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Affiliation(s)
- Dania Daye
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Conant
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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73
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Hitier M, Ho Quoc C, La Marca S, Hamou C, Delay E. Tolérance et efficacité du lipomodelage comme élément de symétrisation en reconstruction mammaire : à propos de 150 patientes. ANN CHIR PLAST ESTH 2014; 59:311-9. [DOI: 10.1016/j.anplas.2014.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
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74
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Lakhiani C, Hammoudeh ZS, Aho JM, Lee M, Rasko Y, Cheng A, Saint-Cyr M. Maximizing aesthetic outcome in autologous breast reconstruction with implants and lipofilling. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0993-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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75
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Ho Quoc C, Piat JM, Michel G, Dlimi C, La Marca S, Delay E. [Fat grafting to improve severe tuberous breast]. ACTA ACUST UNITED AC 2014; 44:503-9. [PMID: 25060865 DOI: 10.1016/j.jgyn.2014.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/28/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tuberous breast is a rare malformation that has major, negative physical and psychological impacts during puberty. A range of surgical techniques has been used to correct breast shape and volume in this context. Most techniques are based on a combination of skin plasty and mammary gland remodelling, in order to redistribute volumes. Prostheses and local-regional flaps can also be used to correct the missing volume. Fat grafting to the breast has been used in our department since 1998 as a complementary technique in breast reconstruction; it constitutes a natural way of providing volume and modifying the shape of the breast. Since 2000, we have extended this lipomodelling technique to the correction of thorax malformations in general and tuberous breasts in particular. Here, we describe our experience of the correction of severe tuberous breasts by fat grafting. PATIENTS AND METHODS Over an 11-year period, we performed a retrospective study on tuberous breast patients treated solely with fat grafting (i.e. without using an implant). Each breast deformation was graded according to the Grolleau classification. After aspiration, the fat was centrifuged and then transferred with a specific cannula. Using an 18-G trocar, we sometimes also performed fasioctomies to free up fibrous bridges and mammary gland remodelling. We evaluated the lipofilling for each case (number of sessions and mean fat transfer volume). Technical efficacy was evaluated in terms of patient's satisfaction and the surgeon's opinion. Safety was evaluated by screening for recipient site complications. RESULTS We performed a retrospective study of 31 cases of tuberous breasts treated between January 2000 and December 2010. The severe tuberous breasts were type 3 in 10 cases. The mean patient age was 21 and the mean body mass index was 21.5. Two session (mean transfer volume: 380 cc) were required in every case. The mean follow-up period after the last fat transfer session was 6 years (range: 1-11). The patients were very satisfied in 90% of cases (n=9) and satisfied in 10% of cases (n=1). No complications were observed. Imaging performed before surgery and one year afterwards did not reveal any anomalies, other than oil cysts. CONCLUSION The treatment of severe tuberous breast with fat grafting is a reliable technique that produces excellent results and high levels of patient satisfaction. The aesthetic outcome is natural, implant-free and long-lasting. Fat grafting decreases local fibrosis and helps (along with fasciotomies and mammary gland remodelling) modify the shape of the breast. The technique corrects the missing volume in a precise, personalized manner. Lipomodelling efficacy and absence of complications have made it our reference treatment for the correction of severe tuberous breasts (as long as the patient has sufficient adipose reserves).
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Affiliation(s)
- C Ho Quoc
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France; International Breast Institute of Orangerie, 11, rue Silbermann, 67000 Strasbourg, France; Cabinet privé, clinique du Val d'Ouest, 39, chemin de la Vernique, 69130 Ecully, France.
| | - J M Piat
- International Breast Institute of Orangerie, 11, rue Silbermann, 67000 Strasbourg, France
| | - G Michel
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - C Dlimi
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - S La Marca
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - E Delay
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
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76
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Chronic Inflammation and Progressive Calcification as a Result of Fat Necrosis. Plast Reconstr Surg 2014; 133:1064-1072. [DOI: 10.1097/prs.0000000000000097] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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77
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Largo RD, Tchang LA, Mele V, Scherberich A, Harder Y, Wettstein R, Schaefer DJ. Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: A systematic review. J Plast Reconstr Aesthet Surg 2014; 67:437-48. [DOI: 10.1016/j.bjps.2013.11.011] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 11/07/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
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78
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Aesthetic Applications of Brava-Assisted Megavolume Fat Grafting to the Breasts. Plast Reconstr Surg 2014; 133:796-807. [DOI: 10.1097/prs.0000000000000053] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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79
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Abstract
BACKGROUND The current standard for breast augmentation involves placement of an implant. As an alternative, surgeons have been exploring breast augmentation with autologous tissue in the form of injectable fat. OBJECTIVES The authors explore the efficacy and safety of lipoaugmentation of the breast, with specific interest in volume changes, fat retention, overall aesthetic improvement, and patient satisfaction. METHODS Direct measurements, 2- and 3-dimensional images, mammograms, and magnetic resonance imaging (MRI) were obtained preoperatively from 10 consecutive patients undergoing augmentation mammaplasty with autologous fat transfer. These measurements were repeated 1 year postoperatively. Postoperative photo imaging was conducted at 3-month intervals for 1 year. Efficacy was evaluated by determining the volume of fat retention 1 year after the procedure with 3-dimensional imaging, standard breast MRI volume measurements, and subjective aesthetic comparisons. RESULTS The average amount of fat injected was 236 cc (90-324; SD, 69.8) in the right breast and 250 cc (90-300; SD, 65.1) in the left. The mean volume change based on 3-dimensional imaging was 85.1 cc (36% retention) for the right breast and 98.1 cc (39.2% retention) for the left. The mean volume change based on MRI measurements was 30.0 cc (39.8% change) on the right and 29.3 cc (38.1% change) on the left. Blinded observers found substantial improvement in 1 patient (10%), moderate improvement in 5 patients (50%), and minimal to no improvement in 4 (40%). Overall patient satisfaction was high, as measured by the abbreviated BREAST-Q. Radiologic abnormalities and artifacts were common and required additional imaging. CONCLUSIONS Objective breast enlargement in this study was modest but yielded disproportionately high subjective patient satisfaction reports. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Scott L. Spear
- Department of Plastic Surgery, Georgetown University Hospital, Washington, DC
| | - Troy Pittman
- Department of Plastic Surgery, Georgetown University Hospital, Washington, DC
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80
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Brenelli F, Rietjens M, De Lorenzi F, Pinto-Neto A, Rossetto F, Martella S, Rodrigues JR, Barbalho D. Oncological Safety of Autologous Fat Grafting after Breast Conservative Treatment: A Prospective Evaluation. Breast J 2014; 20:159-65. [DOI: 10.1111/tbj.12225] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Fabricio Brenelli
- Department of Gyanecology and Obstetrics - Breast Oncology Division; State University of Campinas (Unicamp); Campinas - São Paulo Brazil
- Division of Breast Surgery; São José's Hospital; Beneficencia Portuguesa de São Paulo; São Paulo Brazil
| | - Mario Rietjens
- Division of Plastic and Reconstructive Surgery; European Institute of Oncology; Milan Italy
| | - Francesca De Lorenzi
- Division of Plastic and Reconstructive Surgery; European Institute of Oncology; Milan Italy
| | - Aarão Pinto-Neto
- Department of Gyanecology and Obstetrics - Breast Oncology Division; State University of Campinas (Unicamp); Campinas - São Paulo Brazil
| | - Fabio Rossetto
- Division of Plastic and Reconstructive Surgery; European Institute of Oncology; Milan Italy
| | - Stefano Martella
- Division of Plastic and Reconstructive Surgery; European Institute of Oncology; Milan Italy
| | | | - Daniel Barbalho
- Division of Plastic and Reconstructive Surgery; European Institute of Oncology; Milan Italy
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81
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Alharbi M, Garrido I, Vaysse C, Chavoin JP, Grolleau JL, Chaput B. Latissimus dorsi flap invasion by ductal breast carcinoma after lipofilling. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e68. [PMID: 25289263 PMCID: PMC4186293 DOI: 10.1097/gox.0000000000000012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 09/18/2013] [Indexed: 11/25/2022]
Abstract
Summary: Autologous fat grafting is commonly performed in reconstructive breast surgery but also increasingly in breast augmentation surgery. On the international level, we are witnessing an important increased confidence for this procedure. Nevertheless, it continues to raise questions on the risks of cancer. A 66-year-old patient benefited from a lipofilling to improve a latissimus dorsi flap breast reconstruction, 7 years after initial cancer management. Two years later, constant pain in the flap leads to reoperation. The flap showed a major retraction with histologically massive infiltration of the muscle by an undifferentiated carcinoma of breast origin. The tumor cells were displayed directly in contact with lipofilling inside the muscle. Without establishing any causal link between these 2 events, this case raises the question once more of the risks of breast cancer and encourages us to continue being careful.
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Affiliation(s)
- Muhannad Alharbi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France; and Department of Surgery and Gynecology, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France
| | - Ignacio Garrido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France; and Department of Surgery and Gynecology, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France
| | - Charlotte Vaysse
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France; and Department of Surgery and Gynecology, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France
| | - Jean Pierre Chavoin
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France; and Department of Surgery and Gynecology, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France
| | - Jean Louis Grolleau
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France; and Department of Surgery and Gynecology, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France
| | - Benoit Chaput
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France; and Department of Surgery and Gynecology, Faculty of Medicine, University of Toulouse Rangueil, Toulouse, France
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Breast Reconstruction after a Bilateral Mastectomy Using the BRAVA Expansion System and Fat Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e71. [PMID: 25289266 PMCID: PMC4186296 DOI: 10.1097/gox.0000000000000022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/03/2013] [Indexed: 01/06/2023]
Abstract
Summary: Fat graft breast reconstruction following a mastectomy is always limited by the size of the skin envelope, which affects the amount of graft that can be injected in 1 session. Because the fat graft naturally resorbs in all patients, several sessions of fat grafting are necessary. BRAVA’s negative pressure causes a “reverse” expansion of the skin envelope, thus permitting more space for the fat graft. This allows decreasing number of required procedures for an adequate breast reconstruction. We operated on a 38-year-old patient 4 years after bilateral mastectomy without irradiation for breast cancer. Before the procedure, the patient was instructed to wear the BRAVA system for 12 hours daily for 2 months before the first session, at all times between the sessions and for 1 month following the last fat grafting session. We performed 3 fat grafting sessions, as planned. Altogether, we injected 840 cm3 of fat on the right side and 790 cm3 of fat on the left side. Four months after the last operation, the patient was very satisfied with her new breasts. The breasts were soft, with good sensation and a natural feel. Using the BRAVA external expansion system for the enhancement of fat grafting is a suitable technique for breast reconstruction after a mastectomy. This technique produces soft and natural feeling breasts in fewer operative sessions, with a minimal risk of complications. Patient compliance, however, is greatly needed to achieve the desired results.
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83
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Magnetic resonance imaging and ultrasound evaluation after breast autologous fat grafting combined with platelet-rich plasma. Plast Reconstr Surg 2013; 132:498e-509e. [PMID: 24076696 DOI: 10.1097/prs.0b013e3182a00e57] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast lipofilling is a fairly simple and safe procedure if it is performed by experienced surgeons. METHODS The authors evaluated the radiologic findings from 24 breasts (15 women) subjected to a lipofilling procedure (two sessions) for corrective surgery or cosmetic reasons. Mammography, ultrasound, and magnetic resonance imaging were performed before the first lipofilling session (T0) and 12 months after the last session (T12); ultrasound and magnetic resonance imaging were used 3 months after the first session (Ti) and 3 and 6 months after the last session (T3 and T6). Volumetric evaluations were also made through three-dimensional magnetic resonance imaging reconstruction. RESULTS Ultrasound showed oily cysts in 66.67 percent of the breasts at Ti, 70.83 percent at T3, 62.5 percent at T6, and 45.83 percent at T12, whereas magnetic resonance imaging detected oily cysts in 8.33 percent at Ti and T3 and T6 months and 4.17 percent at T12. At Ti, T3, and T6, the cytosteatonecrotic areas identified on both ultrasound and magnetic resonance imaging were unchanged (8.33 percent), whereas at T12 those cytosteatonecrotic areas were increased on ultrasound (12.5 percent) and even more on the magnetic resonance imaging scans (16.67 percent). The average resorption percentage of injected volume was 15.36 percent at T6 months and 28.23 percent at T12 months. CONCLUSIONS Postlipofilling breast changes can be distinguished from malignant alterations by experienced radiologists and need not interfere with early cancer diagnosis if patients are checked regularly. Moreover, magnetic resonance imaging is very useful for breast volume assessments and for detecting possible changes during longitudinal study. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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84
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Skillman J, Hardwicke J, Whisker L, England D. Attitudes of UK breast and plastic surgeons to lipomodelling in breast surgery. Breast 2013; 22:1200-4. [DOI: 10.1016/j.breast.2013.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/19/2013] [Accepted: 08/25/2013] [Indexed: 11/16/2022] Open
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85
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Bonomi R, Betal D, Rapisarda I, Kalra L, Sajid M, Johri A. Role of lipomodelling in improving aesthetic outcomes in patients undergoing immediate and delayed reconstructive breast surgery. Eur J Surg Oncol 2013; 39:1039-45. [DOI: 10.1016/j.ejso.2013.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 06/21/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022] Open
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86
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Trends in autologous fat grafting to the breast: a national survey of the american society of plastic surgeons. Plast Reconstr Surg 2013; 132:35-46. [PMID: 23806907 DOI: 10.1097/prs.0b013e318290fad1] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Autologous fat grafting has been gaining popularity in recent years, although there remains concern regarding the safety and efficacy of the practice for breast surgery. The purpose of this study was to determine national trends for fat grafting to the breast and to establish the frequency and specific techniques of the procedure to provide more supportive data. METHODS A questionnaire was e-mailed to 2584 members of the American Society of Plastic Surgeons. Variables included prevalence and applications of fat grafting to the breast. Components of the fat graft protocol were also assessed. RESULTS Four hundred fifty-six of the 2584 questionnaires were completed. Sixty-two percent of all respondents reported currently using fat grafting for reconstructive breast surgery and 28% of all respondents reported currently using the practice for aesthetic breast surgery. The most common reason cited by respondents for using fat grafting to the breast was as an adjunctive therapy to implant or flap surgery. CONCLUSIONS Fat grafting to the breast is a common procedure most often used in reconstructive operations. The increasing prevalence of fat grafting to the breast indicates a need for collection of clinical data and supports the establishment of a national prospective registry to track outcomes after aesthetic and reconstructive applications.
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87
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Ho Quoc C, Delaporte T, Meruta A, La Marca S, Toussoun G, Delay E. Breast asymmetry and pectus excavatum improvement with fat grafting. Aesthet Surg J 2013; 33:822-9. [PMID: 23908301 DOI: 10.1177/1090820x13493907] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In women, pectus excavatum malformation can cause modified breast morphology, resulting in mammary asymmetry, which can be increased by placing mammary implants alone. Fat transfer can be an elegant solution to increase the volume and projection of the breast. OBJECTIVES The authors discuss their experience treating pectus excavatum with fat transfer (lipomodeling) since 2000. METHODS The charts of 19 consecutive patients with a pectus excavatum breast asymmetry who underwent lipomodeling treatment at the authors' facility between January 2000 and November 2011 were retrospectively reviewed. Patients were separated using the Chin classification (type 1, 2, and 3). Data points for each patient included age and body mass index, number of interventions and volume of fat injected during each session, total volume transferred, and postoperative complications. The clinical result was evaluated by the patient and the surgical team on a 4-point scale: very good, good, fair, or poor. RESULTS Most (74%) patients in this series had type 3 Chin pectus excavatum. The average age was 28 years, and the average body mass index was 20.3. The average number of lipomodeling sessions was 1.63, and the average volume of fat transferred was 230 mL per session and 375 mL total. The patients and the surgical team were very satisfied or satisfied in 95% of cases and considered the result fair in 5% of cases. There were no complications. CONCLUSIONS Fat transfer for treatment of pectus excavatum yields very good (natural and stable) results and high patient satisfaction rates, which makes this technique our preferred method for treating thoracomammary malformations in pectus excavatum.
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Affiliation(s)
- Christophe Ho Quoc
- Department of Plastic and Reconstructive Surgery, Centre Régional Léon Bérard, 28 rue Leannec, Lyon, France.
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88
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Abstract
INTRODUCTION Tuberous breast is a rare malformation that has negative physical and psychological impacts during puberty. A range of surgical techniques has been used to correct breast shape and volume in this context, including a combination of skin plasty and mammary gland remodeling, as well as prostheses and locoregional flaps. The authors have used fat grafting as a complementary technique to correct tuberous breasts since 1998. OBJECTIVES The authors discuss application of their lipomodeling technique for correction of tuberous breast deformity. METHODS The charts of tuberous breast patients treated consecutively over an 11-year period (n = 31) solely with fat grafting (ie, without using an implant) were retrospectively reviewed. Each breast deformation was graded according to the Grolleau classification. The number of sessions and the mean transfer of fat volume by lipomodeling session were recorded. Patient and surgeon satisfaction were evaluated. RESULTS Of the 31 patients in this series, 18 had bilateral formations and 13 had unilateral malformations. The mean patient age was 23 years, and the mean body mass index was 21.9. A single session (mean transfer volume, 158 mL; range, 90-253 mL) was required in 14 (45%) cases. A second session (mean transfer volume, 226 mL; range, 100-316 mL) was necessary in the remaining 55% of cases. Mean follow-up period after the last fat transfer session was 6.5 years (range, 1.5-11 years). Patients were very satisfied in 94% of cases (n = 29) and satisfied in 6% (n = 2). The surgical team rated 94% of cases as being successful or very successful. No complications were observed. One patient developed hypertrophy of the treated breast following weight gain and thus required breast reduction. Imaging performed preoperatively and 1 year postoperatively did not reveal any anomalies other than oil cysts. CONCLUSION Fat grafting is a reliable technique that produces excellent results and high levels of patient satisfaction for the treatment of tuberous breast. The aesthetic outcome is natural, implant free, and long lasting. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Emmanuel Delay
- Department of Plastic and Reconstructive Surgery, Centre Régional Léon Bérard, Lyon, France
| | - Raphaël Sinna
- Department of Plastic and Reconstructive Surgery, Centre Régional Léon Bérard, Lyon, France
| | - Christophe Ho Quoc
- Department of Plastic and Reconstructive Surgery, Centre Régional Léon Bérard, Lyon, France
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89
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Radiological findings in mammary autologous fat injections: A multi-technique evaluation. Clin Radiol 2013; 68:27-33. [DOI: 10.1016/j.crad.2012.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/16/2012] [Accepted: 05/01/2012] [Indexed: 11/18/2022]
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90
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Differentiating Fat Necrosis from Recurrent Malignancy in Fat-Grafted Breasts. Plast Reconstr Surg 2012; 130:761-772. [DOI: 10.1097/prs.0b013e318262f03b] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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91
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Hsu VM, Stransky CA, Bucky LP, Percec I. Fat grafting's past, present, and future: why adipose tissue is emerging as a critical link to the advancement of regenerative medicine. Aesthet Surg J 2012; 32:892-9. [PMID: 22942117 DOI: 10.1177/1090820x12455658] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Fat grafting is a common reconstructive and aesthetic procedure with extensive clinical applications. Recently, significant strides have been made in investigating the biology behind the success of this procedure. Surgeons and scientists alike have advanced this field by innovating fat graft harvesting and injection techniques, expanding the use of adipose tissue and its stem cell components, and broadening our understanding of the viability of fat grafting at the molecular and cellular levels. The objectives of this review are to (1) discuss the clinical applications of fat grafting, (2) describe the cellular biology of fat and the optimization of fat graft preparation, (3) illustrate the significance of adipose-derived stem cells and the potentiality of fat cells, (4) highlight the clinical uses of adipose-derived stem cells, and (5) explore the current and future frontiers of the study of fat grafting. Although collaborative knowledge has increased exponentially, many of the biological mechanisms behind fat grafting are still unknown. Plastic surgeons are in a unique position to pioneer both the scientific and clinical frontiers of fat grafting and to ultimately further this technology for the benefit of our patients.
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Affiliation(s)
- Vivian M Hsu
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, 19104, USA
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92
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Claro F, Figueiredo JCA, Zampar AG, Pinto-Neto AM. Applicability and safety of autologous fat for reconstruction of the breast. Br J Surg 2012; 99:768-80. [PMID: 22488516 DOI: 10.1002/bjs.8722] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Autologous fat grafting to the breast for cosmetic and reconstructive purposes is still controversial with respect to its safety and efficacy. The objective of this study was to conduct a systematic review of the clinical applicability and safety of the technique. METHODS An online search of the Cochrane Library, MEDLINE, Embase and SciELO was conducted from July 1986 to June 2011. Studies included in the review were original articles of autologous liposuctioned fat grafting to the female breast, with description of clinical complications and/or radiographic changes and/or local breast cancer recurrence. RESULTS This review included 60 articles with 4601 patients. Thirty studies used fat grafting for augmentation and 41 for reconstructive procedures. The incidence of clinical complications, identified in 21 studies, was 3·9 per cent (117 of 3015); the majority were induration and/or palpable nodularity. Radiographic abnormalities occurred in 332 (13·0 per cent) of 2560 women (17 studies); more than half were consistent with cysts. Local recurrence of breast cancer (14 of 616, 2·3 per cent) was evaluated in three studies, of which only one was prospective. CONCLUSION There is broad clinical applicability of autologous fat grafting for breast reconstruction. Complications were few and there was no evidence of interference with follow-up after treatment for breast cancer. Oncological safety remains unclear.
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Affiliation(s)
- F Claro
- Department of Gynaecology and Obstetrics, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil.
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93
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Abstract
Natural breast augmentation, or fat transfer, involves taking fat cells from one area of the body and injecting them into another area, such as the breast. This can be done for cosmetic reasons after a lumpectomy or other surgical procedures that affect the shape of the breast. Breast augmentation is also being used electively by some women to enhance the appearance of their breasts. Defects such as asymmetry, sagging, or indentations have been improved with fat transfers. The changes of the breast tissue from the reaction to the new fat can also change the outcome of mammograms and sonograms. The interpreting radiologist might recommend a biopsy to exclude the possibility of missing a malignant lesion. These two case reports give sonographers an idea of what additional questions they may need to ask patients to clarify their history.
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Veber M, Grecea M, Scevola A, Toussoun G, Pauchot J, Delay E. [Complex breast reconstruction after severe chest trauma by firearm]. ANN CHIR PLAST ESTH 2011; 57:72-8. [PMID: 21459503 DOI: 10.1016/j.anplas.2010.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 12/28/2010] [Indexed: 11/29/2022]
Abstract
This case report is of a 47-year-old woman who suffered a ballistic chest trauma with severe left hemothorax and heart wound. She was treated in emergency for the collapse by heart surgery. Then the coverage for her soft thorax tissue loss was done by an ipsilateral musculocutaneous latissimus dorsi pedicled flap. The patient was subsequently addressed to our team for a repair, especially for reconstruction of the left breast. Initially, rehabilitation of aesthetics units breast was achieved through the realization of an abdominal advancement flap, and breast volume was restored by several sessions of lipomodeling. The surgical alternatives were very limited for this post-traumatic complex breast reconstruction. Due to ballistic trauma, no reliable recipient vessels allowed a microsurgical solution, and the ipsilateral latissimus dorsi was used for the coverage. In conclusion, the restoration of the aesthetics units with lipomodeling has achieved a very good result in this extreme thoracomammary region repair.
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Affiliation(s)
- M Veber
- Service de chirurgie plastique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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