Combined Mastopexy and Augmentation with Autologous Fat Grafting: First Results with Lipopexy

FAM-Fat Augmentation Mastopexy: A Method to Avoid Implants

BACKGROUND

Despite high complication rates, patients persistently present for single-stage augmentation mastopexy. In empty, deflated breasts, we perform one-stage augmentation mastopexy; however, in heavy ptotic breasts, our preference is to stage the procedure with mastopexy and fat graft first. With volume from fat grafting focussing on the upper pole and cleavage areas, many of our patients avoid implants altogether. This reduces subsequent risks of waterfall deformity, implant displacement, rupture and a lifetime of implant exchanges.

OBJECTIVES

We aim to describe our findings and technique for reducing progression to the second stage of a two-stage augmentation mastopexy with the appropriate use of moderate to high volume of fat grafting at the primary operation.

METHODS

This is a retrospective review of all patients who presented to the senior author (KT) requesting breast implants and requiring mastopexy, from January 2018 to December 2022.

RESULTS

Over the five-year period, 137 patients were identified. Seventy-one (51.8%) underwent single-stage augmentation mastopexy, 55 (40.1%) underwent mastopexy with fat grafting and 11 (8.0%) underwent mastopexy with no fat grafting. Our key finding in this study is that 52 of 66 (78.8%) of planned staged patients, who underwent mastopexy with or without fat grafting, were happy with the volume attained and no longer wished to undergo further implant augmentation.

CONCLUSION

In selected patients, appropriate volume and position of fat grafting at the time of primary mastopexy can significantly obviate the need for a second stage implant (alloplastic) augmentation.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optimal strategies for addressing developmental breast asymmetry and the significance of symmetrical treatment: A systematic review

BACKGROUND

Approximately one quarter of women are affected by asymmetry as a result of abnormal breast development, which can lead to significant emotional distress. Despite this, there is currently no widely accepted approach for managing this prevalent condition. This systematic review aimed to review the available literature on the management of developmental breast asymmetry.

METHODS

A comprehensive search in MEDLINE, EMBASE, and CENTRAL databases was conducted for primary clinical studies reporting on the management of developmental breast asymmetry from 1962 to November 2022. The primary outcome measures were long-term aesthetic outcomes and patient-reported outcomes.

RESULTS

Eleven case series and 2 cohort studies were included, comprising a total of 1237 patients with a mean age of 26.5 years (range 14-65 years). Twelve studies (92%) addressed asymmetry through surgical means, using various augmentation and reduction procedures, whereas one study (8%) utilized external prostheses. Meta-analysis of the data was not deemed to be possible because of heterogeneity of data; a narrative synthesis of the literature was provided.

CONCLUSIONS

There is no consensus on how to manage developmental breast asymmetry. Furthermore, there is a lack of consistency in the classification of patients with developmental breast asymmetry and in the reporting of outcomes, highlighting the need for a consensus. Further research outlining long-term aesthetic and patient-reported outcomes is needed to understand which procedures provide optimal outcomes. In addition, external breast prosthesis is a promising nonsurgical alternative, and further studies into its efficacy are needed.

Classification and assessment techniques of breast ptosis: A systematic review

BACKGROUND

Breast ptosis is characterized by the inferolateral descent of the glandular area and nipple-areola complex. A high degree of ptosis may negatively impact a woman's attractiveness and self-confidence. There are various classifications and measurement techniques for breast ptosis used as references in the medical and garment industry. A practical and comprehensive classification will provide accurate standardized definitions of the degrees of ptosis to facilitate the development of corrective surgeries and well-fitting undergarments for women in need.

METHODS

A systematic review on the classification and assessment techniques to measure breast ptosis was carried out based on the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the modified Newcastle-Ottawa scale for observational studies, whereas the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to evaluate randomized studies.

RESULTS

Of 2550 articles identified in the literature search, 16 observational and 2 randomized studies describing the classification and assessment techniques of breast ptosis were included in the review. A total of 2033 subjects were involved. Half of the total observational studies had a Newcastle-Ottawa scale score of 5 and above. In addition, all randomized trials recorded a low overall bias.

CONCLUSION

A total of 7 classifications and 4 measurement techniques for breast ptosis were identified. However, most studies did not demonstrate a clear derivation of sample size beside lacking robust statistical analysis. Hence, further studies that apply the latest technology to combine the strength of previous assessment techniques are needed to develop better classification system that is applicable to all affected women.

Autologous Adipose-Derived Tissue Stromal Vascular Fraction (AD-tSVF) for Knee Osteoarthritis

Adipose tissue contains adult mesenchymal stem cells that may modulate the metabolism when applied to other tissues. Stromal vascular fraction (SVF) can be isolated from adipose tissue mechanically and/or enzymatically. SVF was recently used to decrease the pain and improve the function of knee osteoarthritis (OA) patients. Primary and/or secondary OA causes inflammation and degeneration in joints, and regenerative approaches that may modify the natural course of the disease are limited. SVF may modulate inflammation and initiate regeneration in joint tissues by initiating a paracrine effect. Chemokines released from SVF may slow down degeneration and stimulate regeneration in joints. In this review, we overviewed articular joint cartilage structures and functions, OA, and macro-, micro-, and nano-fat isolation techniques. Mechanic and enzymatic SVF processing techniques were summarized. Clinical outcomes of adipose tissue derived tissue SVF (AD-tSVF) were evaluated. Medical devices that can mechanically isolate AD-tSVF were listed, and publications referring to such devices were summarized. Recent review manuscripts were also systematically evaluated and included. Transferring adipose tissues and cells has its roots in plastic, reconstructive, and aesthetic surgery. Micro- and nano-fat is also transferred to other organs and tissues to stimulate regeneration as it contains regenerative cells. Minimal manipulation of the adipose tissue is recently preferred to isolate the regenerative cells without disrupting them from their natural environment. The number of patients in the follow-up studies are recently increasing. The duration of follow up is also increasing with favorable outcomes from the short- to mid-term. There are however variations for mean age and the severity of knee OA patients between studies. Positive outcomes are related to the higher number of cells in the AD-tSVF. Repetition of injections and concomitant treatments such as combining the AD-tSVF with platelet rich plasma or hyaluronan are not solidified. Good results were obtained when combined with arthroscopic debridement and micro- or nano-fracture techniques for small-sized cartilage defects. The optimum pressure applied to the tissues and cells during filtration and purification of the AD-tSVF is not specified yet. Quantitative monitoring of articular joint cartilage regeneration by ultrasound, MR, and synovial fluid analysis as well as with second-look arthroscopy could improve our current knowledge on AD-tSVF treatment in knee OA. AD-tSVF isolation techniques and technologies have the potential to improve knee OA treatment. The duration of centrifugation, filtration, washing, and purification should however be standardized. Using gravity-only for isolation and filtration could be a reasonable approach to avoid possible complications of other methodologies.

One-Stage Mastopexy-Lipofilling in Cosmetic Breast Surgery: A Prospective Study

INTRODUCTION

Mastopexy in combination with implant breast augmentation still remains a controversial topic in plastic surgery because of its complexity and its relative high rate of complications. To obviate the need of a breast implant, numerous authors described glandular rearrangement techniques to optimize upper pole fullness and breast projection. More recently, the combination of mastopexy and lipofilling has been described. The aim of this study is to report our experience on one-stage mastopexy-lipofilling in cosmetic breast surgery, describing our surgical technique and focusing on long-term esthetic results and patient-reported outcomes.

MATERIAL AND METHOD

A prospective observational study was performed including all patients underwent cosmetic one-stage mastopexy-lipofilling. Collected data included patient's age and BMI, smoking, preoperative and postoperative cup size and grade of ptosis, preoperative and postoperative distances between the upper part of the nipple areola complex and the inframammary fold and between the upper part of the nipple areola complex and the sternal notch, mean liposuction and fat injection volume, mean operating time and postoperative complications. Cosmetic results and patient satisfaction were evaluated using the 5 points Likert scale considering breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape and global satisfaction.

RESULTS

A total of 21 patients (42 breasts) were included with a mean follow-up of 13.8 months. Mean liposuction and injection volumes were 1070 mL and 230 mL, respectively. With respect to breast size, 11 patients (52.4%) showed an increase in one-cup size, while 10 patients (47.6%) showed a slight increase in volume without changing cup size. The mean NAC-SN and NAC-IMF distances decreased by an average of 3.7 cm and 1.7 cm, respectively. Regarding esthetic outcomes, the mean scores for breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape were 4.1, 4.2, 4.9, 4, 4.6 and 5, respectively. With respect to patient satisfaction, mean scores for breast volume, shape, symmetry, quality of scars, nipple areola complex and donor site shape were 4.2, 5, 5, 4.7, 5 and 5, respectively. The achievement of a satisfactory outcome (> 4) was obtained in all patients but 1 with a mean score of 4.5 (3-5).

CONCLUSION

The current study suggests that one-stage mastopexy-lipofilling is a safe technique, which leads with satisfactory outcomes allowing breast contouring and breast volume increase.

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.

Stem Cells in Autologous Microfragmented Adipose Tissue: Current Perspectives in Osteoarthritis Disease

Osteoarthritis (OA) is a chronic debilitating disorder causing pain and gradual degeneration of weight-bearing joints with detrimental effects on cartilage volume as well as cartilage damage, generating inflammation in the joint structure. The etiology of OA is multifactorial. Currently, therapies are mainly addressing the physical and occupational aspects of osteoarthritis using pharmacologic pain treatment and/or surgery to manage the symptomatology of the disease with no specific regard to disease progression or prevention. Herein, we highlight alternative therapeutics for OA specifically considering innovative and encouraging translational methods with the use of adipose mesenchymal stem cells.

Comparative technical analysis of lipoaspirate mechanical processing devices

Fat grafting is a well-established procedure in reconstructive, aesthetic, and regenerative medicine, in particular due to the presence in the adipose tissue of a high concentration of mesenchymal stem cells. The need to reduce fat processing times, for an immediate clinical use and regulatory restrictions on the degree of manipulation of human tissues, has led to the development of numerous devices for the mechanical, nonenzymatic processing of adipose tissue. The aim of this study is to describe the state of the art of mechanical devices used for fat processing, performing a technical analysis of the currently commercially available devices. This should facilitate the development of new devices that improve therapeutic results.