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Li Z, Zhang Z, Zhang Z, Guan X, Xin M. Hybrid Breast Augmentation: Double Benefit or Double Risk? A Comparative Study of 932 Cases. Plast Reconstr Surg 2024; 153:325-335. [PMID: 37010471 DOI: 10.1097/prs.0000000000010498] [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: 04/04/2023]
Abstract
BACKGROUND The authors propose a hybrid breast augmentation (HBA) method combining implants and fat grafting and explore the outcome and safety through a retrospective, single-center, propensity score-matched, comparative study. METHODS Outcome, satisfaction, and complications were compared between the HBA group (302 cases) and the implant-based breast augmentation (IBA) group (353 cases), and between the HBA group and the autologous fat grafting (AFG) group (277 cases). RESULTS The mean follow-up period was 31.7 months. After propensity score matching (PSM), 270 cases were matched between the HBA and IBA groups, and 156 cases were matched between the HBA and AFG groups. Compared with the IBA group, HBA achieved higher scores of implant visibility/palpability and upper pole contour with the specialists' evaluations (before and after PSM; P < 0.05). Regarding patient satisfaction, the scores of softness (before and after PSM), smoothness of the upper pole (before PSM), and overall satisfaction (after PSM) of the HBA group were better ( P < 0.05). Implant-related complications occurred at a similar rate. Compared with the AFG group, HBA achieved higher scores of shape (before and after PSM) and symmetry (after PSM) with evaluations by specialists ( P < 0.05). The scores of shape, symmetry, and overall satisfaction in the HBA group were better (before and after PSM; P < 0.05). The HBA group showed a lower incidence of palpable cysts, fat necrosis, oil cysts, and fat calcification (before PSM; P < 0.05). CONCLUSION When the three techniques were compared objectively, HBA presented better indices of aesthetic outcomes, satisfaction, and acceptable complications rates when compared with IBA and AFG. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Zhengyao Li
- From the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ziying Zhang
- From the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zixuan Zhang
- From the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaoyu Guan
- From the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Minqiang Xin
- From the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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Optimizing Prepectoral Implant Placement and Concomitant Fat Grafting After Tissue Expansion. Ann Plast Surg 2023:00000637-990000000-00218. [PMID: 36921323 DOI: 10.1097/sap.0000000000003446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
BACKGROUND Prepectoral implant-based breast reconstruction is often supplemented by autologous fat grafting to optimize aesthetic outcomes. This usually entails several rounds of modest fat transfer to minimize risk of necrosis; however, the limits of fat grafting at expander exchange are not known. METHODS A single-institution retrospective review from July 2016 to February 2022 was performed of all patients who underwent (1) mastectomy, (2) prepectoral tissue expander placement, (3) expander exchange for implant, and (4) at least one round of autologous fat transfer. Student t test and χ2 test were used. RESULTS A total of 82 breasts underwent a single round of fat grafting during implant placement (group 1); 75 breasts underwent fat grafting that occurred in multiple rounds and/or in delay to implant placement (group 2). Group 1 received more fat at the time of implant placement (100 mL; interquartile range, 55-140 mL; P < 0.001) and underwent fewer planned operative procedures compared with group 2 (1.0 vs 2.2, P < 0.001). Total fat volume in group 2 did not significantly exceed that of group 1 until after 3 rounds of fat transfer (128.5 mL; interquartile range, 90-130 mL; P < 0.01). There was no difference in the rate of fat necrosis between groups after the first round (15.9% vs 9.3%, P = 0.2) and final round (15.9% vs 12.0%, P = 0.5) of fat grafting. Complication rates were similar between groups (3.7% vs 8.0%, P = 0.2). CONCLUSIONS A 2-stage approach of prepectoral tissue expander placement with single round of larger volume fat transfer at expander exchange reduces overall number of operative procedures without increased risks.
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Paredes H, Murature SG, Aliaga N, Donaire JM, Lira MT, Sola A. Lipotransferencia de protección en pacientes con implantes irradiados: análisis preliminar de complicaciones inmediatas. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Siennicka K, Piotrowski P, Olszewski W, Gajewska M, Mazur S, Pojda Z. In Vivo Supportive Effects of Mesenchymal Stem Cells on Fat Graft Stabilization and Local Induction of Angiogenesis Are Not Dependent on the Cell Donor Age or In Vitro Cell Culture Duration. Rejuvenation Res 2021; 24:441-448. [DOI: 10.1089/rej.2021.0042] [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)
- Katarzyna Siennicka
- Department of Regenerative Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Paweł Piotrowski
- Department of Regenerative Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Wojciech Olszewski
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Marta Gajewska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Sławomir Mazur
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Zygmunt Pojda
- Department of Regenerative Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Jeyaraman M, Muthu S, Sharma S, Ganta C, Ranjan R, Jha SK. Nanofat: A therapeutic paradigm in regenerative medicine. World J Stem Cells 2021; 13:1733-1746. [PMID: 34909120 PMCID: PMC8641019 DOI: 10.4252/wjsc.v13.i11.1733] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/15/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Adipose tissue is a compact and well-organized tissue containing a heterogeneous cellular population of progenitor cells, including mesenchymal stromal cells. Due to its availability and accessibility, adipose tissue is considered a “stem cell depot.” Adipose tissue products possess anti-inflammatory, anti-fibrotic, anti-apoptotic, and immunomodulatory effects. Nanofat, being a compact bundle of stem cells with regenerative and tissue remodeling potential, has potential in translational and regenerative medicine. Considering the wide range of applicability of its reconstructive and regenerative potential, the applications of nanofat can be used in various disciplines. Nanofat behaves on the line of adipose tissue-derived mesenchymal stromal cells. At the site of injury, these stromal cells initiate a site-specific reparative response comprised of remodeling of the extracellular matrix, enhanced and sustained angiogenesis, and immune system modulation. These properties of stromal cells provide a platform for the usage of regenerative medicine principles in curbing various diseases. Details about nanofat, including various preparation methods, characterization, delivery methods, evidence on practical applications, and ethical concerns are included in this review. However, appropriate guidelines and preparation protocols for its optimal use in a wide range of clinical applications have yet to be standardized.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida 201306, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
| | - Sathish Muthu
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, Tamil Nadu, India
| | - Shilpa Sharma
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, New Delhi, India
| | - Charan Ganta
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Stem Cells and Regenerative Medicine, Kansas State University, Manhattan, United States 10002, United States
| | - Rajni Ranjan
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida 201306, Uttar Pradesh, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
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Skillman J, McManus P, Bhaskar P, Hamilton S, Roy PG, O'Donoghue JM. UK Guidelines for Lipomodelling of the Breast on behalf of Plastic, Reconstructive and Aesthetic Surgery and Association of Breast Surgery Expert Advisory Group. J Plast Reconstr Aesthet Surg 2021; 75:511-518. [PMID: 34895855 DOI: 10.1016/j.bjps.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
Lipomodelling has become increasingly popular for reconstructive, aesthetic and therapeutic indications. The guidelines summarise available evidence for indications, training, technique, audit and outcomes in lipomodelling and also highlight areas for further research.
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Affiliation(s)
- Joanna Skillman
- Consultant Plastic Surgeon, University Hospital Coventry and Warwickshire NHS Trust.
| | - Penelope McManus
- Consultant Oncoplastic Breast Surgeon, University Hospitals of Morecambe Bay NHS Foundation Trust
| | - Pud Bhaskar
- Consultant Oncoplastic Breast Surgeon, North Tees and Hartlepool NHS Trust
| | - Stephen Hamilton
- Consultant Plastic Surgeon, Royal Free London NHS Foundation Trust
| | - P G Roy
- Consultant Oncoplastic Breast Surgeon, Oxford University Hospitals
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Sforza M, Spear S. Hybrid Implant and Grafted Fat Breast Augmentation: Designing the Pathway to a Future With Breasts Free of Silicone Breast Implants. Aesthet Surg J 2021; 41:NP1473-NP1485. [PMID: 33944894 PMCID: PMC8564703 DOI: 10.1093/asj/sjab195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fat grafting in breast augmentation surgery is becoming increasingly popular, allowing surgeons to fill the gaps that implant augmentation alone cannot. However, one of the current issues surrounding fat grafting is the lack of standardization. OBJECTIVES The objective of this study was to validate and summarize expert-based advice to help plastic surgeons better understand the benefits of utilizing fat grating to reduce implant size in their surgical planning. METHODS This was a prospective study of fat grafting in 56 patients who underwent fat transfer together with silicone breast implants. A 3-dimensional planning system was used to plan the procedure and also to analyze the fat retention and resorption rates. Pictures served as a basis for a questionnaire in which both patients and physicians were asked to rate their satisfaction. RESULTS Patients reported a satisfaction rate of "excellent" in 83.3% of cases and "good" in 16.7%. Physician satisfaction was rated as "excellent" in 84.5% of cases, "good" in 13.3%, and "fair" in 4.2% of cases. The mean fat volume grafted per breast was 113.63 mL. The mean absorption rate was 4.53%. CONCLUSIONS The procedure presented consistent and reproducible results. Hybrid breast augmentation can help design a pathway for a future with breasts free of silicone. This information is particularly relevant for women who have their first breast augmentation at an early age and will probably have 2 to 5 additional surgeries in their lifetime due to the nature of current silicone breast technology. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Marcos Sforza
- Corresponding Author: Dr Marcos Sforza, Dolan Park Hospital, Stoney Lane, Bromsgrove B60 1LY, UK. E-mail: ; Instagram: @marcossforza
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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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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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Mughal M, Sindali K, Man J, Roblin P. 'Fat chance': a review of adipose tissue engineering and its role in plastic and reconstructive surgery. Ann R Coll Surg Engl 2021; 103:245-249. [PMID: 33682428 DOI: 10.1308/rcsann.2020.7031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons. Standard methods of reconstruction such as local tissue transfer and free autologous tissue transfer are successful in addressing soft tissue cover, yet they do not come without the additional morbidity of donor sites. Autologous fat transfer has been used in reconstruction of soft tissue defects in different branches of plastic surgery, specifically breast and facial defect reconstruction, while further maintaining a role in body contouring procedures. Current autologous fat transfer techniques come with the drawbacks of donor-site morbidity and, more significantly, resorption of large amounts of fat. Advancement in tissue engineering has led to the use of engineered adipose tissue structures based on adipose-derived stem cells. This enables a mechanically similar reconstruct that is abundantly available. Cosmetic and mechanical similarity with native tissue is the main clinical goal for engineered adipose tissue. Development of novel techniques in the availability of natural tissue is an exciting prospect; however, it is important to investigate the potential of cell sources and culture strategies for clinical applications. We review these techniques and their applications in plastic surgery.
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Affiliation(s)
- M Mughal
- St Thomas' Hospital, London, UK.,University College London, London, UK
| | | | - J Man
- St Thomas' Hospital, London, UK
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Christodoulides N, Kelly GA, O'Sullivan ST. Breast lipofilling as a treatment for breast hypoplasia in Becker naevus syndrome: a case report. J Surg Case Rep 2021; 2021:rjaa583. [PMID: 33542812 PMCID: PMC7850009 DOI: 10.1093/jscr/rjaa583] [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: 11/24/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023] Open
Abstract
A Becker's naevus is a rare, pigmented, cutaneous hamartoma, which when associated with other cutaneous or musculoskeletal anomalies is termed Becker naevus syndrome. Female patients commonly seek medical attention for breast hypoplasia. Here, we describe our experience in the surgical management of unilateral breast hypoplasia in a patient with Becker naevus syndrome, using high-volume autologous fat grafting. This is, to our knowledge, the second report in the literature describing the aforementioned management technique in this patient cohort.
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Affiliation(s)
- Natasha Christodoulides
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Gerard A Kelly
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Sean T O'Sullivan
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Wilton, Cork, Ireland
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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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Abdallah IE, Ayoub R, Sawaya R, Saba SC. Iatrogenic sciatic nerve injury during liposuction and fat tissue grafting: a preventable surgical complication with devastating patient outcomes. Patient Saf Surg 2020; 14:40. [PMID: 33110447 PMCID: PMC7585210 DOI: 10.1186/s13037-020-00265-3] [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: 08/11/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Liposuction and autologous fat transplantation represent widely used techniques in plastic surgery to correct or enhance contour irregularities in the face and body. While these techniques are assumed to be safe, liposuction and fat grafting impose a hidden risk for serious preventable surgical complications and adverse patient outcomes. We hereby report two cases of iatrogenic sciatic nerve injury and provide recommendations on how to prevent this serious surgical complication. Case presentation We present two cases of sciatic nerve injury - one related to liposuction and the other related to gluteal lipo-augmentation. The first case is a 20-year-old female who presented to our institution with right leg weakness one week after undergoing scar revision and fat grafting in the left peri-oral region to correct peri-oral cicatricial banding and tissue atrophy. Fat was harvested from the medial thigh using a 3-mm cannula with low-pressure manual suction, utilizing minimal tumescent solution. Nerve conduction velocity and electromyography testing suggested a right-sided sciatic nerve lesion as a result of direct trauma. The patient was observed for a period of 4 months during which time she underwent physical therapy. At four months post-operatively, she had recovered completely. The second case is that of a 39-year-old female who presented to our institution with left-sided weakness of foot eversion and dorsiflexion five days after she had undergone liposuction of the thighs, flanks, and abdomen in addition to gluteal lipo-augmentation at an outside facility. The patient had undergone super wet liposuction in the areas of the abdomen, flanks and thighs. 200 mL of collected fat was then transplanted into each buttock at multiple levels. Post-operative computed tomography and electroneurography revealed acute left sided sciatic injury consistent with direct trauma to or compression of the sciatic nerve. The patient underwent an extensive regimen of physical therapy. Three months post-operatively, the patient had regained some motor function, but was lost to follow-up thereafter. Conclusion The sciatic nerve is relatively superficial and vulnerable to injury in the upper thigh and lower buttock regions. Therefore, extreme care should be taken when working in these areas to avoid direct or indirect injury to the sciatic nerve by compression or traction.
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Affiliation(s)
- Ibrahim E Abdallah
- Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020 Lebanon
| | - Rita Ayoub
- Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020 Lebanon
| | - Raja Sawaya
- Department of Neurology, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020 Lebanon
| | - Salim C Saba
- Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020 Lebanon
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Maximiliano J, Munhoz AM, Pedron M, de Oliveira ACP, Duarte DW, Neto R, Portinho CP, Collares MVM. Hybrid Breast Augmentation: A Reliable Formula for Preoperative Assessment of Fat Graft Volume Based on Implant Volume and Projection. Aesthet Surg J 2020; 40:NP438-NP452. [PMID: 31960904 DOI: 10.1093/asj/sjaa017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Autogenous fat grafting (AFG) is an established technique used as an adjunct to breast augmentation (BA) to redesign breast shape. Surgeons often use experience and intuition to estimate AFG volume, which can result in incorrect assessment of donor areas and unnecessary fat removal. OBJECTIVES This aim of this study was to develop a method based on a mathematical formula, which utilizes implant volume and projection to predict AFG volume. METHODS Thirty patients (60 breasts) underwent primary hybrid BA. A software package (SketchUp) was used to simulate 3-dimensional AFG and implant volumes, which in turn were used to develop an equation for estimating AFG volume according to 3 different implant projections. The results for each group were compared, via Pearson's correlation coefficient, with the results of the clinical series. RESULTS All patients received Motiva Ergonomix SmoothSilk/SilkSurface implants, ranging in volume from 175 to 355 cc (mean, 265 cc), as well as an average AFG volume of 79.2 cc/breast (range, 50-110 cc). Twenty-nine patients (96.6%) were either very satisfied or satisfied during a mean follow-up of 18 months (range, 6-28 months). A high correlation was observed between the AFG performed in the cohort and predictions obtained from the formula (r = 0.938, P < 0.001). CONCLUSIONS The AFG volume in hybrid BA procedures can be estimated utilizing measurements based on implant volume/projection. This low-cost method can be applied to guide surgical decision-making in patients who are candidates for BA. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- João Maximiliano
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | - Alexandre Mendonça Munhoz
- Division of Plastic Surgery, Hospital Sírio-Libanês; Chief of the Breast Surgery Group, Division of Plastic Surgery, University of São Paulo School of Medicine; and Coordinator, Plastic Surgery Department, Hospital Moriah, São Paulo, Brazil
| | | | | | - Daniele Walter Duarte
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | - Rafael Neto
- Division of Plastic Surgery, Hospital Moinhos de Vento, Porto Alegre-RS, Brazil
| | - Ciro Paz Portinho
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
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Optimization of the Parameters of Different Purification Techniques and Comparison of Their Purification Efficiency and Their Effects on the Metabolic Activity of Adipose Tissue in Autologous Fat Transplantation. J Craniofac Surg 2020; 31:662-667. [DOI: 10.1097/scs.0000000000006157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Munhoz AM. Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and Implications. Plast Reconstr Surg 2020; 145:868e-869e. [PMID: 32221245 DOI: 10.1097/prs.0000000000006704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandre Mendonça Munhoz
- Hospital Sírio-Libanês, Cancer Institute of São Paulo, University of São Paulo, Hospital Moriah, São Paulo, Brazil
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18
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Oncologic safety of immediate autologous fat grafting for reconstruction in breast-conserving surgery. Breast Cancer Res Treat 2020; 180:301-309. [PMID: 32026213 DOI: 10.1007/s10549-020-05554-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/31/2020] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Autologous fat grafting (AFG), or lipofilling, has been used for immediate reconstruction at the time of breast-conserving surgery in order to achieve a satisfactory cosmetic outcome in patients with breast cancer and an unfavorable tumor-to-breast volume ratio or unfavorable tumor location. However, the oncologic safety of this technique is still unclear. OBJECTIVE To determine whether AFG performed simultaneously with breast-conserving surgery is associated with differences in local relapse rates and disease-free survival. DESIGN Matched retrospective cohort study. SETTING Tertiary referral center. PARTICIPANTS Patients undergoing breast-conserving surgery with or without AFG between 2004 and 2016 were retrospectively enrolled and matched for age, staging, grade, tumor histology, and tumor immunohistochemical profile. MAIN OUTCOME(S) AND MEASURE(S) The cumulative incidence of locoregional recurrence (LRR) and disease-free survival were the primary end points, while distant recurrence and overall survival were the secondary end points. RESULTS A total of 320 patients were followed. Cases were matched with controls at a 1:4 ratio. There was no difference in LRR or distant recurrence of breast cancer between the two groups. The annual LRR rate was 0.86% in patients who received immediate AFG vs. 0.7% in patients undergoing breast-conserving surgery alone (p ≥ 0.05). Number of lymph nodes was the sole independent risk factor for local recurrence (p = 0.045). No significant differences in disease-free survival rates were found between the groups. CONCLUSIONS AND RELEVANCE At a mean follow-up of 5 years, no significant differences in locoregional recurrence rates were found between patients who received immediate AFG and those who underwent breast-conserving surgery alone. These findings corroborate previous research demonstrating the oncological safety of immediate AFG reconstruction, further suggesting that this technique as a safe, effective way to achieve optimal cosmetic outcomes in primary breast cancer surgery without jeopardizing oncologic outcomes.
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The use of autologous fat grafts in breast surgery: A literature review. Arch Plast Surg 2019; 46:498-510. [PMID: 31775202 PMCID: PMC6882697 DOI: 10.5999/aps.2019.00416] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022] Open
Abstract
Autologous fat injection was first described roughly a century ago and has been used in surgery ever since. In addition to its use in many surgical fields, it is also frequently used for both aesthetic and reconstructive purposes in breast surgery. Since the application of fat grafting in breast surgery has steadily increased, studies investigating its reliability have simultaneously become increasingly common. Previous studies have reported that the use of fat grafting in breast surgery is reliable, but some pending questions remain about its routine use. In order to use fat grafts successfully in breast surgery, it is necessary to be familiar with the structure and content of adipose tissue, the efficacy of adipose stem cell-enriched fat grafts, the oncological safety of fat grafts, and the problems that may occur in the radiological follow-up of patients who undergo fat grafting procedures. In this literature review, we aim to discuss the use of fat grafts in breast surgery by investigating these common problems.
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Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and Implications. Plast Reconstr Surg 2019; 144:265-275. [PMID: 31348325 DOI: 10.1097/prs.0000000000005790] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors' aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors that trigger the ordering process. METHODS A retrospective chart review was conducted for patients from 2006 to 2015 who underwent fat grafting as part of implant-based breast cancer reconstruction and had at least 1-year follow-up after fat grafting. RESULTS From 2006 to 2015, 166 patients underwent fat grafting as part of implant-based breast reconstruction. Forty-four women (26.5 percent) underwent at least one imaging procedure. Thirteen women (7.8 percent) underwent 17 biopsies. For a palpable mass, the initial imaging test most commonly ordered was ultrasound, followed by mammography/ultrasound. The percentage of patients with a diagnosis of fat necrosis on mammography, ultrasound, and biopsy was 4.2, 12.7, and 5.4 percent, respectively. Seven patients (4.2 percent) had distant metastases. Tissue diagnosis of local recurrence was never identified. Mean follow-up was 2.4 years. CONCLUSIONS Fat-grafting sequelae may lead to early unplanned invasive and noninvasive procedures initiated by a variety of providers. In this study, fat grafting had no impact on local recurrence rate. As use of fat grafting grows, communication among breast cancer care providers and enhanced patient and caregiver education will be increasingly important in optimizing the multidisciplinary evaluation and monitoring of palpable breast lesions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Scioli MG, Storti G, D'Amico F, Gentile P, Kim BS, Cervelli V, Orlandi A. Adipose-Derived Stem Cells in Cancer Progression: New Perspectives and Opportunities. Int J Mol Sci 2019; 20:ijms20133296. [PMID: 31277510 PMCID: PMC6651808 DOI: 10.3390/ijms20133296] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022] Open
Abstract
Growing importance has been attributed to interactions between tumors, the stromal microenvironment and adult mesenchymal stem cells. Adipose-derived stem cells (ASCs) are routinely employed in regenerative medicine and in autologous fat transfer procedures. To date, clinical trials have failed to demonstrate the potential pro-oncogenic role of ASC enrichment. Nevertheless, some pre-clinical studies from in vitro and in vivo models have suggested that ASCs act as a potential tumor promoter for different cancer cell types, and support tumor progression and invasiveness through the activation of several intracellular signals. Interaction with the tumor microenvironment and extracellular matrix remodeling, the exosomal release of pro-oncogenic factors as well as the induction of epithelial-mesenchymal transitions are the most investigated mechanisms. Moreover, ASCs have also demonstrated an elective tumor homing capacity and this tumor-targeting capacity makes them a suitable carrier for anti-cancer drug delivery. New genetic and applied nanotechnologies may help to design promising anti-cancer cell-based approaches through the release of loaded intracellular nanoparticles. These new anti-cancer therapies can more effectively target tumor cells, reaching higher local concentrations even in pharmacological sanctuaries, and thus minimizing systemic adverse drug effects. The potential interplay between ASCs and tumors and potential ASCs-based therapeutic approaches are discussed.
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Affiliation(s)
- Maria Giovanna Scioli
- Anatomic Pathology Institute, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Gabriele Storti
- Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Federico D'Amico
- Anatomic Pathology Institute, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Pietro Gentile
- Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Bong-Sung Kim
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Valerio Cervelli
- Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology Institute, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
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Simonacci F, Bertozzi N, Grieco MP, Raposio E. From liposuction to adipose-derived stem cells: indications and technique. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:197-208. [PMID: 31124996 PMCID: PMC6776224 DOI: 10.23750/abm.v90i2.6619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 01/08/2023]
Abstract
Background and aim of the work: Adipose tissue is an organ of energy storage, an endocrine organ, a soft tissue filler and a cosmetically unnecessary tissue discarded by liposuction. Liposuction was designed to correct unaesthetic deposits of subcutaneous fat; it produces satisfactory silhouette contouring when performed by appropriately trained operators using properly selected technologies. However, from lipoaspirate it is possible to obtain autologous fat graft and adipose-derived stem cells (ASCs) for reconstructive surgery and regenerative medicine. Autologous fat transplantation uses include the correction of body contour, malformations and post-surgical outcomes. The regenerative properties of ASCs allow treating damaged tissues such as wounds, burns, scars and radiodermatitis. The aim of this study was to perform a literature review highlighting the crucial role of adipose tissue in plastic and reconstructive surgery, from liposuction to lipofilling and ASCs, exposing the indications, procedures and complications of these surgical techniques. Methods: Literature review of publications concerning liposuction, lipofilling and adipose-derived stem cells (ASCS). Results: The introduction of liposuction allowed the use of adipose tissue for many clinical uses. The adipose tissue filling properties have been highlighted by the advent of lipofilling. The regenerative properties evidence of autologous fat transplantation encouraged the research on the clinical use of ASCs. Conclusions: Adipose tissue is not only the main energy storage of our body but also an important source of stem cells that can be used in various fields of regenerative medicine and tissue engineering with encouraging results for the future. (www.actabiomedica.it)
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Affiliation(s)
- Francesco Simonacci
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy and the Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy..
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Safety Profiles of Fat Processing Techniques in Autologous Fat Transfer for Breast Reconstruction. Plast Reconstr Surg 2019; 143:985-991. [PMID: 30921112 DOI: 10.1097/prs.0000000000005424] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Autologous fat transfer is common in breast reconstruction because of its versatility for use in contour deformities. The authors examined three different fat grafting processing techniques for complications and safety profile using their institutional database. METHODS Retrospective review was performed of patients from a single institution who had undergone autologous fat transfer following breast reconstruction from 2012 to 2016. Individuals were separated into three cohorts according to fat harvest technique: (1) centrifugation, (2) Telfa gauze, or (3) Revolve. Complications between the groups were assessed. RESULTS A total of 267 cases of autologous fat transfer were identified (centrifugation, n = 168; Telfa, n = 44; and Revolve, n = 55). Grafting by means of centrifugation was associated with the greatest incidence of oil cysts (12.5 percent; p = 0.034), postoperative adverse events observed in the clinic (13.7 percent; p = 0.002), and total complications (25.6 percent; p = 0.001). The use of Telfa resulted in the lowest rates of oil cyst formation (0 percent; p = 0.002) and total complications (2.3 percent; p = 0.001). Grafting by means of centrifugation was also associated with the highest frequency of repeated injections among the three techniques after initial grafting (19.6 percent; p = 0.029). In contrast, Revolve demonstrated a repeated injection rate of just 5.45 percent, significantly lower when independently compared with centrifugation (p = 0.011). Multivariate analysis demonstrated that higher total graft volume (p = 0.002) and the use of centrifugation (p = 0.002) were significant risk factors for adverse events seen in the clinic postoperatively. CONCLUSIONS Significant differences in postoperative outcomes exist between varying fat transfer techniques. Autologous fat transfer by means of centrifugation harbored the highest rates of complication, whereas Telfa and Revolve exhibited similar safety profiles. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Kang D, Luan J. Fat Necrosis After Autologous Fat Transfer (AFT) to Breast: Comparison of Low-Speed Centrifugation with Sedimentation. Aesthetic Plast Surg 2018; 42:1457-1464. [PMID: 30132108 DOI: 10.1007/s00266-018-1213-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/05/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite the advantages of autologous fat transfer to the breast, there are many complications after the surgery, such as oil cysts, calcification and palpable breast nodules. The fat purification process is a key step to reduce those complications, but there is currently no standard processing method. This study was designed to compare the incidence of fat necrosis after autologous fat grafting to the breast with low-speed centrifugation and sedimentation. METHODS This study analyzed 100 patients (167 breasts) who underwent autologous fat grafts to the breasts from January, 2015 to March, 2017. Patients were divided into two groups randomly, low-speed centrifugation (800 r/min) and sedimentation (15 min). Postoperative fat necrosis such as oil cysts and palpable breast nodules was measured using physical examination and breast ultrasound 3 months after the surgery. The number and the diameter of the fat necroses were detected. RESULTS A total of 100 patients (167 breasts) were included this research. There were 21 breasts with clinically palpable nodules (12.57%); fifteen (19.48%) were in the low-speed centrifugation group and six (6.67%) were in the sedimentation group (p < 0.05). According to postoperative breast ultrasounds, there were 83 breasts with hypoechoic cyst formations (49.7%); forty-five (58.44%) in the low-speed centrifugation group and 38 (42.22%) in the sedimentation group (p < 0.05). A positive correlation between the number of operative sessions and fat necrosis was found out. CONCLUSION Although low-speed centrifugation could achieve higher fat purification efficacy when compared with sedimentation, it causes more fat necrosis than sedimentation, such as clinically palpable nodules and subclinical nodules, especially in patients who had a history of breast surgery and those who needed more than one fat grafting session. LEVEL OF EVIDENCE III 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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25
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Relationship between Tamoxifen and the Absorption of Subfascial Autologous Fat Grafts. Plast Reconstr Surg 2018; 141:1408-1415. [PMID: 29750763 DOI: 10.1097/prs.0000000000004415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the lipofilling procedures used in breast reconstruction, there is an unpredictability in the rate of reabsorption of the grafted fat. The objective of this study was to analyze the effect of tamoxifen, a medication commonly prescribed for patients with breast cancer, as a possible alternative to reduce the rate of autologous fat graft resorption. METHODS The fatty cushion of the inguinal region of 20 female adult Wistar rats was removed and then autografted, using a standard volume of 0.2 ml in the subfascial plane of the dorsal region. The subject animals were randomized into two groups, the control and study groups. The study group animals were administered 20 mg/kg/day of tamoxifen citrate over a period of 21 days, by means of gavage. At the end of the experiment, the animals were killed and the grafts underwent morphologic and histopathologic analysis, with emphasis on the predominant inflammatory response pattern and collagen maturation. RESULTS The rats undergoing treatment with tamoxifen (study group) presented higher values in relation to the weight and volume of fat grafts compared with the initial values and the control group. Histologic analysis using hematoxylin and eosin staining showed that resolution of the inflammatory process was faster in the control group. Analysis using the picrosirius method demonstrated higher percentages of immature collagen versus mature collagen. CONCLUSION Use of tamoxifen reduced the rates of resorption and fibrosis of the injected fat, resulting in better integration of the autologous fat graft.
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Leslie LJ, Sheena Y, Shepherd DE, Ismail A, Kukureka SN, Vijh V. In vitro investigation into the forces involved during lipofilling. Proc Inst Mech Eng H 2018; 232:1111-1116. [PMID: 30284941 DOI: 10.1177/0954411918804272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Breast augmentation using implants is the most common aesthetic and reconstructive breast surgical procedure. Complications such as implant rupture maybe related to surgical technique and damage to the implant. Autologous fat transfer (lipofilling) using metallic cannulae has become a standard adjunctive, yet there is little evidence on lipofilling safety in the presence of implants. The aims of this study are to verify the effects of different cannulae and to quantify the forces applied by surgeons during lipofilling. Silicone gel-filled textured implants (200 mL), mounted on a specially constructed mould were ruptured with two different cannulae: type A (hole at tip: sharp) and type B (hole away from tip: blunt), driven at three speeds (10, 100 and 1000 mm/min), and the force at rupture was recorded. In addition, the maximum 10 forces over a 30-s period applied by 11 plastic surgeons against a breast implant in an in vitro environment were recorded using a load cell attached to a type-A cannula. Statistical analysis of comparative results was performed using t-tests, with p < 0.05 considered significant. Results showed that the implant ruptured at forces up to 25% lower when cannula A was used compared to cannula B. This supports current technique in lipofilling in the use of a blunt tipped cannula. There was a significant difference between some displacement rates only, due to the viscoelastic nature of the material. The tactile force that surgeons use during lipofilling was modelled in vitro and showed a range of maximum forces between 0.23 and 16.8 N, with a mean maximum value of 6.9 N. Limitation of this study is that it may not reflect in vivo behaviour of breast implants. More studies are needed to confirm the safety of breast lipofilling in the presence of implants using these data as a starting point.
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Affiliation(s)
- Laura J Leslie
- 1 Aston Institute of Materials Research, Aston University, Birmingham, UK
| | - Yezen Sheena
- 2 Department of Burns and Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Duncan Et Shepherd
- 3 School of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Amir Ismail
- 2 Department of Burns and Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Stephen N Kukureka
- 4 School of Metallurgy and Materials, University of Birmingham, Birmingham, UK
| | - Vik Vijh
- 2 Department of Burns and Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK
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Krastev TK, Alshaikh GA, Hommes J, Piatkowski A, van der Hulst RR. Efficacy of autologous fat transfer for the correction of contour deformities in the breast: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2018; 71:1392-1409. [DOI: 10.1016/j.bjps.2018.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 12/16/2022]
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Stumpf CC, Biazus JV, Zucatto FSÂE, Cericatto R, Cavalheiro JAC, Damin APS, Melo MP. Immediate reconstruction with autologous fat grafting: influence in breast cancerregional recurrence. ACTA ACUST UNITED AC 2018; 44:179-186. [PMID: 28658337 DOI: 10.1590/0100-69912017002012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/09/2016] [Indexed: 12/20/2022]
Abstract
Objective to evaluate local and systemic recurrence of breast cancer in patients submitted to autologous fat grafting in the immediate reconstruction after conservative surgery for breast cancer. Methods this is a historical cohort study comparing 167 patients submitted to conservative surgery without reconstruction (conservative surgery group) with 27 patients submitted to conservative treatment with immediate graft reconstruction, following the Coleman's technique (lipofilling group). All patients had invasive carcinoma and were operated by a single surgeon from 2004 to 2011. The postoperative follow-up time was 36 months. Results the overall incidence of local recurrence was 2.4%. No patient in the lipofilling group had local recurrence during the study period. For systemic recurrence, the rates obtained were 3.7% (one patient) for the fat grafting group and 1.8% (three patients) for the conservative surgery group without reconstruction. Conclusion there was no significant difference for local or systemic recurrence in the groups studied. Immediate autologous fat grafting appears to be a safe procedure.
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Affiliation(s)
- Camile Cesa Stumpf
- - Clinics Hospital of Porto Alegre, Breast Unit, Porto Alegre, Rio Grande do Sul State, Brazil
| | - Jorge Villanova Biazus
- - Clinics Hospital of Porto Alegre, Breast Unit, Porto Alegre, Rio Grande do Sul State, Brazil
| | | | - Rodrigo Cericatto
- - Clinics Hospital of Porto Alegre, Breast Unit, Porto Alegre, Rio Grande do Sul State, Brazil
| | | | | | - Márcia Portela Melo
- - Clinics Hospital of Porto Alegre, Breast Unit, Porto Alegre, Rio Grande do Sul State, Brazil
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Hersant B, Bouhassira J, SidAhmed-Mezi M, Vidal L, Keophiphath M, Chheangsun B, Niddam J, Bosc R, Nezet AL, Meningaud JP, Rodriguez AM. Should platelet-rich plasma be activated in fat grafts? An animal study. J Plast Reconstr Aesthet Surg 2018; 71:681-690. [PMID: 29477267 DOI: 10.1016/j.bjps.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/22/2017] [Accepted: 01/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The adjunction of platelet-rich plasma with graft fat has been the subject of a few clinical trials which have demonstrated its value in adipocyte survival. The aim of this study was to assess the different efficacies between activated and non-activated PRP on adipose cells in vitro and for adipose tissue graft survival in vivo. METHODS The in vitro study assessed the effects of PRP on both the proliferation and adipocyte differentiation of adipose cells. For the in vivo study, 8 nude rats received 3 human fat injections as follows: 0.8 mL of fat + 0.2 mL of normal saline; 0.8 mL of fat + 0.2 mL of non-activated PRP; and 0.8 mL of fat + 0.2 mL of PRP activated with calcium chloride (CaCl2). The quantitative assessment of adipocyte survival was implemented after 3 months using histomorphometric analysis. Histological and immunohistochemical analysis were also performed to evaluate angiogenesis, inflammation and quality of adipocytes in the grafted tissue. RESULTS We showed that activated PRP stimulated, in vitro, proliferation and differentiation of adipose cells. In vivo experiments indicated that CaCl2-activated PRP was more efficient than non-activated to prolong the survival of fat grafts in nude rats. The mean percentage areas occupied by viable adipocytes in the PRP-free group, non-activated PRP group and activated PRP group were 13%, 14% and 24% (p = 0.05%), respectively. Histological and immunohistochemical analysis revealed protective effect of activated PRP on inflammation and adipocyte death. CONCLUSION This study showed that activation by CaCl2 improves the beneficial effects of PRP for fat graft maintenance.
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Affiliation(s)
- Barbara Hersant
- Department of Plastic, Reconstructive and Aesthetic Surgery, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny 94000, Creteil, France; UPEC, University Paris Est Creteil, Val de Marne, France; INSERM U955, Equipe 12, Creteil, France
| | - Jonathan Bouhassira
- Department of Plastic, Reconstructive and Aesthetic Surgery, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny 94000, Creteil, France; UPEC, University Paris Est Creteil, Val de Marne, France; INSERM U955, Equipe 12, Creteil, France.
| | - Mounia SidAhmed-Mezi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny 94000, Creteil, France; UPEC, University Paris Est Creteil, Val de Marne, France; INSERM U955, Equipe 12, Creteil, France
| | - Luciano Vidal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny 94000, Creteil, France; UPEC, University Paris Est Creteil, Val de Marne, France
| | - Mayoura Keophiphath
- DIVA expertise, 1 place Pierre Potier BP 50624, 31106 Cedex 1, Toulouse, France
| | - Barbara Chheangsun
- DIVA expertise, 1 place Pierre Potier BP 50624, 31106 Cedex 1, Toulouse, France
| | - Jeremy Niddam
- Department of Plastic, Reconstructive and Aesthetic Surgery, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny 94000, Creteil, France; UPEC, University Paris Est Creteil, Val de Marne, France
| | - Romain Bosc
- Department of Plastic, Reconstructive and Aesthetic Surgery, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny 94000, Creteil, France; UPEC, University Paris Est Creteil, Val de Marne, France
| | | | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive and Aesthetic Surgery, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny 94000, Creteil, France; UPEC, University Paris Est Creteil, Val de Marne, France; INSERM U955, Equipe 12, Creteil, France
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Van Nieuwenhove I, Tytgat L, Ryx M, Blondeel P, Stillaert F, Thienpont H, Ottevaere H, Dubruel P, Van Vlierberghe S. Soft tissue fillers for adipose tissue regeneration: From hydrogel development toward clinical applications. Acta Biomater 2017; 63:37-49. [PMID: 28941654 DOI: 10.1016/j.actbio.2017.09.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/05/2017] [Accepted: 09/19/2017] [Indexed: 02/08/2023]
Abstract
There is a clear and urgent clinical need to develop soft tissue fillers that outperform the materials currently used for adipose tissue reconstruction. Recently, extensive research has been performed within this field of adipose tissue engineering as the commercially available products and the currently existing techniques are concomitant with several disadvantages. Commercial products are highly expensive and associated with an imposing need for repeated injections. Lipofilling or free fat transfer has an unpredictable outcome with respect to cell survival and potential resorption of the fat grafts. Therefore, researchers are predominantly investigating two challenging adipose tissue engineering strategies: in situ injectable materials and porous 3D printed scaffolds. The present work provides an overview of current research encompassing synthetic, biopolymer-based and extracellular matrix-derived materials with a clear focus on emerging fabrication technologies and developments realized throughout the last decade. Moreover, clinical relevance of the most promising materials will be discussed, together with potential concerns associated with their application in the clinic.
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Autologous Fat Grafting as a Novel Antiestrogen Vehicle for the Treatment of Breast Cancer. Plast Reconstr Surg 2017; 140:537-544. [PMID: 28841614 DOI: 10.1097/prs.0000000000003579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Adipose fat transfer is increasingly used for contour corrections of the tumor bed after lumpectomy and breast reconstructions after mastectomy. The lipophilic nature of the fat tissue may render adipocytes an ideal vehicle with which to deliver a high boost of an antiestrogen to the tumor bed to serve as an adjunct systemic hormonal therapy. The authors therefore tested whether adipocytes could safely be loaded with an antiestrogen and allow for release at therapeutic concentrations to treat breast cancer. METHODS Adipose tissue was collected from patients undergoing autologous fat grafting. The influence of adipose tissue on tumorigenesis was determined both in vitro and in vivo using breast cancer cell lines. Ex vivo, adipose tissue was assessed for its ability to depot fulvestrant and inhibit the growth of breast cancer cell lines. RESULTS Adipose tissue harvested from patients did not promote breast cancer cell growth in vitro or in an in vivo mouse model. Adipose tissue was successfully loaded with fulvestrant and released at levels sufficient to inhibit estrogen receptor signaling and growth of breast cancer cells. CONCLUSIONS This work supports the hypothesis that adipose tissue used for autologous fat grafting can serve as a novel method for local drug delivery. As this technique is used to reconstruct a variety of postsurgical defects following cancer resection, this approach for local drug delivery may be an effective alternative in therapeutic settings beyond breast cancer.
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Is Centrifugation Necessary for Processing Lipoaspirate Harvested via Water-Jet Force Assisted Technique before Grafting? Evidence of Lipoaspirate Concentration With Enhanced Fat Graft Survival. Ann Plast Surg 2017; 77:477-84. [PMID: 27070683 DOI: 10.1097/sap.0000000000000718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although water-jet force-assisted liposuction technique (WAL) was demonstrated to have favorable effects on fat grafting, controversy continues concerning the application of centrifugation for lipoaspirate harvested via WAL. As a controversial technique, plastic surgeons often get perplexed to the necessity of using centrifugation during fat grafting procedure. In the present study, we adopted the recommended centrifugal intensity (1200g, 3 minutes) to process lipoaspirate and focused on the influence of centrifugation on the fate of lipoaspirate harvested with WAL technique. METHODS Lipoaspirate was obtained from 10 healthy Chinese female patients who underwent cosmetic liposuction. The harvested lipoaspirate was either not centrifuged (group A) or centrifuged at 1200g for 3 minutes (group B). Lipoaspirate from each group was compared in the in vitro and in vivo experiments. The influence of centrifugation on lipoaspirate viability and lipoaspirate survival after grafting were evaluated. RESULTS The viability of the lipoaspirates was similar between equally volumetric uncentrifugal and centrifugal lipoaspirate. However, centrifugation at 1200g for 3 minutes concentrated stromal vascular fraction cells and adipose-derived stem cells in lipoaspirate; greater angiogenesis and weight retention rates were observed in centrifugal lipoaspirate after grafting than those uncentrifugal lipoaspirate. CONCLUSIONS Centrifugation at 1200g for 3 minutes enhanced the survival of lipoaspirate harvested via WAL technique after grafting. Centrifugation at 1200g for 3 minutes was recommended to process lipoaspirate harvested with water-jet force assistance before grafting.
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Abstract
Cosmetic and reconstructive surgeries always have a primary aim of the best outcome for the patient, with a big emphasis on the aesthetics. Lipomodelling is one such technique, originally described over a century ago but still used to this day, to provide a patient with the highest quality results. This is particularly true for lipomodelling of the breast, whether it be purely cosmetic, or for a post-mastectomy reconstruction for a breast cancer patient. Lipomodelling provides an effective way of restoring and even improving the look and aesthetics of the breast and of helping achieve the patient's expectations. With the added advantage of being autologous, the procedure is safe and effective. This review discusses the latest guidelines and literature on autologous lipomodelling.
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Affiliation(s)
- Ketan Agarwal
- Core Surgical Trainee, Department of Urology, Royal Liverpool and Broadgreen University Hospital, Liverpool L7 8XP
| | - Meera Mistry
- Foundation Year 1 Doctor, Department of Respiratory Medicine, Royal Liverpool and Broadgreen University Hospital, Liverpool
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Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg (Lond) 2017; 20:49-60. [PMID: 28702187 PMCID: PMC5491488 DOI: 10.1016/j.amsu.2017.06.059] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. PATIENTS AND METHODS Literature review of publications concerning autologous fat grafting. RESULTS Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The "wet" method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. CONCLUSIONS Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.
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Affiliation(s)
- Francesco Simonacci
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele Pio Grieco
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Eugenio Grignaffini
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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The Evolution of Photography and Three-Dimensional Imaging in Plastic Surgery. Plast Reconstr Surg 2017; 139:761-769. [DOI: 10.1097/prs.0000000000003146] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Outcomes of Prosthetic Reconstruction of Irradiated and Nonirradiated Breasts with Fat Grafting. Plast Reconstr Surg 2017; 139:1e-9e. [DOI: 10.1097/prs.0000000000002916] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Petit JY, Lohsiriwat V, Rietjens M. Lipofilling. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Autologous fat transplantation for breast reconstruction: A literature review. Ann Med Surg (Lond) 2016; 12:94-100. [PMID: 27942383 PMCID: PMC5137333 DOI: 10.1016/j.amsu.2016.11.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The use of autologous fat transplantation to correct volume and contour defects, scars, and asymmetry after breast cancer surgery has increased over the past 20 years. Many developments and refinements in this technique have taken place in recent years, and several studies of the safety of lipofilling in the breast have been published. PRESENTATION OF CASE We performed a literature review of this technique, highlighting the crucial role of lipofilling in breast cancer reconstruction. DISCUSSION The efficacy of the fat graft transplantation depends on the experience and the technique used by the surgeon. The ASCs (adipose-derived stem cells) contained in the fat graft has proven to be crucial for breast reconstruction by mean the regeneration of tissue, through the chemotactic, paracrine, and immunomodulatory activities and their in situ differentiation. CONCLUSION The role of lipofilling for breast reconstruction could be more significant with the application of the findings of experimental research on tissue engineering and ASCs.
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Affiliation(s)
- Francesco Simonacci
- Department of Surgical Sciences, Plastic Surgery Division, University of Parma, Parma, Italy
- The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Nicolò Bertozzi
- Department of Surgical Sciences, Plastic Surgery Division, University of Parma, Parma, Italy
- The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele Pio Grieco
- Department of Surgical Sciences, Plastic Surgery Division, University of Parma, Parma, Italy
- The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Eugenio Grignaffini
- Department of Surgical Sciences, Plastic Surgery Division, University of Parma, Parma, Italy
- The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Edoardo Raposio
- Department of Surgical Sciences, Plastic Surgery Division, University of Parma, Parma, Italy
- The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Waked K, Colle J, Doornaert M, Cocquyt V, Blondeel P. Systematic review: The oncological safety of adipose fat transfer after breast cancer surgery. Breast 2016; 31:128-136. [PMID: 27837706 DOI: 10.1016/j.breast.2016.11.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 10/02/2016] [Accepted: 11/03/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Oncological concerns have risen around the safety of adipose fat transfer (AFT) after breast cancer surgery. In this article, we present the clinical and molecular evidences, and discuss the current contradiction between them. MATERIALS AND METHODS Every clinical trial and experimental study on AFT and its oncological influences was screened. Between September 2014 and September 2016, 856 articles from four databases were found. 105 core articles were selected. RESULTS A total of 18 clinical studies have been published. The loco-regional recurrence (LRR) incidence rates range between 0 and 3.90% per year. For the mastectomy and breast conservative therapy group separately, a LRR per year between 0 and 1.62% and 0-3.90 has been reported, respectively. Some studies included a matched control group and found no significant difference between cases and controls, with the exception of a subgroup of patients with intraepithelial breast carcinoma. Adipose derived mesenchymal stem cells have a potential oncogenic effect on residual cancer cells after breast cancer surgery. Numerous signalling proteins and pathways have been described that can stimulate tumour initiation and growth. CONCLUSION There is a contradiction between experimental and clinical findings. Numerous adipokines have been discovered that could potentially promote tumour initiation and growth, but clinical studies fail to point out a significant increase in LRR in patients who receive AFT after breast cancer surgery. More prospective studies are needed with a sufficient follow-up time and analysis of some critical factors, such as adjuvant radiotherapy and hormonal therapy, the origin and volume of the injected fat, and genetic influences.
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Affiliation(s)
- Karl Waked
- University Hospital of Ghent, De Pintelaan 185, 9000 Gent, Belgium.
| | - Julien Colle
- University Hospital of Ghent, De Pintelaan 185, 9000 Gent, Belgium.
| | - Maarten Doornaert
- Private Medical Center: Maaltebrugge Ghent, Maaltebruggestraat 288, 9000 Gent, Belgium.
| | | | - Phillip Blondeel
- University Hospital of Ghent, De Pintelaan 185, 9000 Gent, Belgium.
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De Decker M, De Schrijver L, Thiessen F, Tondu T, Van Goethem M, Tjalma WA. Breast cancer and fat grafting: efficacy, safety and complications-a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 207:100-108. [PMID: 27835828 DOI: 10.1016/j.ejogrb.2016.10.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 10/07/2016] [Accepted: 10/21/2016] [Indexed: 01/19/2023]
Abstract
Autologous fat grafting (AFG) or lipofilling is nowadays a popular technique for breast reconstruction after breast cancer surgery. There is debate regarding the oncological safety and risks of this procedure in breast cancer patients. A systematic review of the literature published between January first 1995 and October first 2016 was conducted regarding the efficacy, safety and complications of this technique in breast cancer patients after their cancer treatment. The databases PubMed, Science Direct and Thomson Reuters Web of Science were used to search for qualified articles. Inclusion criteria were women with a personal history of breast cancer and at least one lipofilling procedure. Only studies containing a minimum of 20 patients were included in this systematic review. The search yielded a total of 23 suitable articles: 18 case series, 4 retrospective cohort studies and one prospective cohort study. The systematic review encompassed a total of 2419 patients. Medical imaging was used in the majority of the studies to assess the follow-up. Mammography was the most popular technique (65.2%), followed by ultrasound (47.8%) and MRI (30.4%). The prevalence of complications was the following: fat necrosis in 5.31%, benign lesions, like cysts or calcifications in 8.78%, infections in 0.96% and local cancer recurrence in 1.69%. AFG or lipofilling appears to be an oncological safe technique with a low morbidity in women with a history of breast cancer. In order to have a better understanding and evidence of the oncological safety a randomised controlled trial is urgently needed. We further recommend that all AFG be registered in the cancer register.
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Affiliation(s)
- M De Decker
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - L De Schrijver
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - F Thiessen
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Plastic Surgery Unit, Antwerp University Hospital, Antwerpen, Belgium
| | - T Tondu
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Plastic Surgery Unit, Antwerp University Hospital, Antwerpen, Belgium
| | - M Van Goethem
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Department of Radiology, Antwerp University Hospital, Antwerpen, Belgium
| | - W A Tjalma
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Unit of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium.
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Sforza M, Andjelkov K, Zaccheddu R, Husein R, Atkinson C. A Preliminary Assessment of the Predictability of Fat Grafting to Correct Silicone Breast Implant-Related Complications. Aesthet Surg J 2016; 36:886-94. [PMID: 27155193 DOI: 10.1093/asj/sjw060] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 02/29/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fat grafting in breast augmentation surgery is becoming increasingly popular and is allowing surgeons to fill the gaps that implant augmentation alone cannot. However, one current issue surrounding fat grafting is resorption. OBJECTIVES In this prospective study, the authors present their experience of fat grafting and resorption in 26 patients who had fat transfer to correct deformities or asymmetries following primary breast enlargement surgery. METHODS The fat utilized was harvested and processed using the Puregraft system. Fat grafting was performed until the problem was visually corrected, followed by an additional 30% overcorrection. Photographs were taken preoperatively and 1 year postoperatively, and analyzed utilizing cloud-based 3-dimensional imaging software to measure the breast volumes and calculate 1-year resorption rates. Both patients and physicians were asked to rate their satisfaction. RESULTS The total volume of fat transferred ranged from 160 cc to 360 cc, with an average of 280 cc per procedure. The absolute volume of tissue resorption showed considerable variation (median, 42.6 mL; range, 5.5-62 mL). However, there was a very close correlation between the volume resorbed and the volume implanted: the more volume injected, the more volume absorbed. When expressed as a percentage of implanted tissue, the resorption rate was 27.5 ± 0.8% (mean ± standard deviation) with a very narrow range (25.7%-28.9%). Patients and physicians reported a satisfaction rate of "excellent" in 83.3% and 75% of cases, respectively. CONCLUSIONS At 1 year, 25.7% to 28.9% of the injected fat had been resorbed in a predictable, reproducible, and effective manner. LEVEL OF EVIDENCE 4 Therapeutic.
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Gentile P, Sarlo F, De Angelis B, De Lorenzo A, Cervelli V. Obesity phenotypes and resorption percentage after breast autologous fat grafting: Rule of low-grade inflammation. Adv Biomed Res 2016; 5:134. [PMID: 27656603 PMCID: PMC5025913 DOI: 10.4103/2277-9175.187396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 05/25/2016] [Indexed: 12/24/2022] Open
Abstract
Background: One of the main reasons why the breast fat grafting was questioned is that there may be lipofilling resorption. In the literature, the resorption rate reported over the 1st year is highly variable (20–90%). Objective: The aim of this work was to identify the biochemical and clinical parameters, which increase fat graft maintenance in breast reconstruction. Materials and Methods: A sample of 19 patients was treated with fat grafting mixed with platelet-rich plasma. A complete screening of anthropometry, body composition, and blood biochemical parameters was assessed using the standardized equipment. Pre- and post-operative evaluation was performed, which included a complete clinical examination, photographic assessment, nuclear magnetic resonance imaging of the soft tissue, and ultrasound. The follow-up period was 2 years. Results: The authors divided the results into two types of patients: “responder” and “not a responder.” In the “responder” group patients with normal weight, gynoid fat distribution, obese, with normal blood biochemical parameters, and atherogenic indices but with high preoperative values of platelet-to-lymphocyte ratio (PLR) (174.49) and neutrophil-lymphocyte ratio (NLR) (2.65) showed a greater increase of fat graft maintenance at 6 and 12 months after the last lipofilling session. In the “not responder group” patients with overweight, android fat distribution, obese, high values of atherogenic indices, but with normal preoperative NLR and PLR ratios showed a lower fat graft maintenance at 6 and 12 months. Conclusion: We assume, the problem of fat resorption may be resolved by analysis of body composition and by examine the predictive role of preoperative markers of low-grade inflammation.
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Affiliation(s)
- Pietro Gentile
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, Italy; Department of Plastic and Reconstructive Surgery, Catholic University, Tirane, Albania
| | - Francesca Sarlo
- Department of Biomedicine and Prevention, Division of Clinical Nutrition and Nutrigenomics, University of Rome Tor Vergata, Rome, Italy
| | - Barbara De Angelis
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, Italy; Department of Plastic and Reconstructive Surgery, Catholic University, Tirane, Albania
| | - Antonio De Lorenzo
- Department of Biomedicine and Prevention, Division of Clinical Nutrition and Nutrigenomics, University of Rome Tor Vergata, Rome, Italy
| | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, Italy
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Erdmann-Sager J, Wu LC. Advances in Immediate Breast Reconstruction and Reconstruction after Breast Conservation. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0153-2] [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]
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Pittet-Cuénod B, Rüegg EM, Thomet C, Lomessy A, Modarressi A. Techniques de reconstruction mammaire et indications dans la prise en charge des femmes à haut risque. IMAGERIE DE LA FEMME 2016. [DOI: 10.1016/j.femme.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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Bozkurt M, Kapı E, Şirinoğlu H, Güvercin E, Filinte GT, Filinte D. The effects of the centrifugation speed on the survival of autogenous fat grafts in a rat model. J Plast Surg Hand Surg 2016; 50:161-6. [DOI: 10.3109/2000656x.2015.1137926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oncological outcomes of lipofilling breast reconstruction: 195 consecutive cases and literature review. J Plast Reconstr Aesthet Surg 2016; 69:475-81. [PMID: 26876108 DOI: 10.1016/j.bjps.2015.12.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/08/2015] [Accepted: 12/22/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Lipofilling has become a widely used procedure in breast reconstruction after mastectomy or breast-conserving treatment. The possibility that this technique may increase stimulation of cancer development between the potential tumor bed and the lipoaspirates grafts has been raised regarding its safety. The aim of this study was to identify the oncological risks associated with this procedure in our institution. METHODS Between years 2007 and 2014 we record 195 consecutive patients with fat grafting technique for reconstructive purpose after breast cancer treatment. The loco-regional recurrence (LRR) as first event of relapse was the primary end point of this study. RESULTS We performed 319 lipofilling procedures in 132 mastectomy and 63 breast-conserving surgery patients. Invasive carcinoma represents 81.6% of the series. The median follow-up from primary cancer surgery and fat grafting was 74 and 31 months respectively. Median time between oncologic surgery and lipofilling was 36 months. The authors observed a complication rate of 8.2%, most of them liponecrosis and oil cysts (7.2%). Four local, 2 regional and 4 distant recurrences were observed as first event of relapse in 10 patients with invasive ductal carcinoma. The loco-regional recurrence rate was 3.1% (1.08% per year). CONCLUSIONS Although larger prospective trials are needed, these results support the fact that lipofilling following breast cancer treatment leads to a very low rate of complications and similar to other authors, it does not seem to interfere in patient's oncological prognosis when compared with prior publications.
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Roll, Spin, Wash, or Filter? Processing of Lipoaspirate for Autologous Fat Grafting: An Updated, Evidence-Based Review of the Literature. Plast Reconstr Surg 2015; 136:706-713. [PMID: 26397249 DOI: 10.1097/prs.0000000000001581] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of autologous adipose tissue harvested through liposuction techniques for soft-tissue augmentation has become commonplace among cosmetic and reconstructive surgeons alike. Despite its longstanding use in the plastic surgery community, substantial controversy remains regarding the optimal method of processing harvested lipoaspirate before grafting. This evidence-based review builds on prior examinations of the literature to evaluate both established and novel methods for lipoaspirate processing. METHODS A comprehensive, systematic review of the literature was conducted using Ovid MEDLINE in January of 2015 to identify all relevant publications subsequent to the most recent review on this topic. Randomized controlled trials, clinical trials, and comparative studies comparing at least two of the following techniques were included: decanting, cotton gauze (Telfa) rolling, centrifugation, washing, filtration, and stromal vascular fraction isolation. RESULTS Nine articles comparing various methods of processing human fat for autologous grafting were selected based on inclusion and exclusion criteria. Five compared established processing techniques (i.e., decanting, cotton gauze rolling, centrifugation, and washing) and four publications evaluated newer proprietary technologies, including washing, filtration, and/or methods to isolate stromal vascular fraction. CONCLUSIONS The authors failed to find compelling evidence to advocate a single technique as the superior method for processing lipoaspirate in preparation for autologous fat grafting. A paucity of high-quality data continues to limit the clinician's ability to determine the optimal method for purifying harvested adipose tissue. Novel automated technologies hold promise, particularly for large-volume fat grafting; however, extensive additional research is required to understand their true utility and efficiency in clinical settings.
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