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Bonomi F, Limido E, Weinzierl A, Harder Y, Menger MD, Laschke MW. Preconditioning Strategies for Improving the Outcome of Fat Grafting. TISSUE ENGINEERING. PART B, REVIEWS 2024. [PMID: 38818802 DOI: 10.1089/ten.teb.2024.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Autologous fat grafting is a common procedure in plastic, reconstructive, and aesthetic surgery. However, it is frequently associated with an unpredictable resorption rate of the graft depending on the engraftment kinetics. This, in turn, is determined by the interaction of the grafted adipose tissue with the tissue at the recipient site. Accordingly, preconditioning strategies have been developed following the principle of exposing these tissues in the pretransplantation phase to stimuli inducing endogenous protective and regenerative cellular adaptations, such as the upregulation of stress-response genes or the release of cytokines and growth factors. As summarized in the present review, these stimuli include hypoxia, dietary restriction, local mechanical stress, heat, and exposure to fractional carbon dioxide laser. Preclinical studies show that they promote cell viability, adipogenesis, and angiogenesis, while reducing inflammation, fibrosis, and cyst formation, resulting in a higher survival rate and quality of fat grafts in different experimental settings. Hence, preconditioning represents a promising approach to improve the outcome of fat grafting in future clinical practice. For this purpose, it is necessary to establish standardized preconditioning protocols for specific clinical applications that are efficient, safe, and easy to implement into routine procedures.
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Affiliation(s)
- Francesca Bonomi
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg, Germany
| | - Ettore Limido
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg, Germany
| | - Andrea Weinzierl
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg, Germany
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg, Germany
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Biermann N, Eigenberger A, Felthaus O, Brébant V, Heine N, Brix E, Spoerl S, Prantl L, Gurtner G, Anker AM. Breast Lipofilling: Is the Bra Really Full? Clinical Bra Pressure Measurement and In Vitro Testing of Processed and Unprocessed Fat Cells. Aesthetic Plast Surg 2024:10.1007/s00266-024-04116-9. [PMID: 38814346 DOI: 10.1007/s00266-024-04116-9] [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: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Breast lipofilling, a popular cosmetic and reconstructive procedure, involves the transplantation of autologous fat to enhance breast volume and contour. Despite its widespread use, cell processing and the aftertreatment remain controversial. This study investigates the pressure applied by a compression bra and reports in vitro stress tests of processed and unprocessed fat cells. METHODS Clinical bra pressure measurements were conducted on a cohort of 45 patients following lipofilling, reduction mammoplasties and DIEP flaps. Laboratory analysis included cell vitality testing using Resazurin assays of processed and unprocessed fat cells after exposure to mechanical or hyperbaric pressure. RESULTS Our findings show a mean overall pressure value of the compression bra for all patients of 6.7 ± 5.7 mmHg (range 0-35). Cell processing is superior to sedimentation only regarding fat cell vitality. However, neither mechanical pressure within the specified range nor hyperbaric oxygen exposure significantly affected fat graft survival as measured by Resazurin assays. CONCLUSION The in vitro measurements showed that it was impossible to harm fat cells with external pressure during lipofilling procedures, regardless of their processing. In the clinical context, the compression bra applied pressure values deceeding the perfusion pressure and may therefore not diminish oxygen supply nor harm the transplanted cells. Therefore, we recommend the use of a compression bra for all lipofilling procedures around the breast. 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 Table of Contents or online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany.
| | - Andreas Eigenberger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
- Medical Device Lab, Regensburg Center of Biomedical Engineering (RCBE), Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Galgenbergstraße 30, 93053, Regensburg, Germany
| | - Oliver Felthaus
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Vanessa Brébant
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Norbert Heine
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Eva Brix
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Steffen Spoerl
- Clinic and Polyclinic for Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Geoffrey Gurtner
- Department of Plastic and Reconstructive Surgery, Stanford University School Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Alexandra M Anker
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
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Wang Z, Zhang Y, Xu Y, Cai J, Gao J, Zhang P. Establishment of Early Blood Perfusion Promotes CXCL12 Expression and Recruits Monocytes/Macrophages in Damaged Adipose Tissue in Mice Model. Aesthetic Plast Surg 2024:10.1007/s00266-024-04103-0. [PMID: 38769146 DOI: 10.1007/s00266-024-04103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/25/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Blood perfusion in the recipient site is important for adipose tissue repair after fat grafting. It delivers host-derived macrophages derived from monocytes in bone marrow to initiate inflammatory reactions and regenerative responses. According to the ability of CXCL12, a stromal cell-derived factor, to recruit monocytes/macrophages, we studied its effect on adipose tissue repair and regeneration under ischemic and normal conditions. METHODS Each inguinal fat pad was crushed for 30 seconds with a clamp in mice (n = 35). The left inguinal vessels were divided and cut off (ischemic group), while the right inguinal vessels were kept patent (control group). Seven animals were sacrificed at 1, 3, 7, 14, and 30 days after surgery, and macrophages (Mac2 and CD206) and adipocytes (perilipin) were assessed. Levels of inflammatory factors (interleukin (IL)-1β, IL-6, and tumor necrosis factor-α) and CXCL12 were measured by quantitative PCR. RESULTS The number of macrophages was higher in the control group than in the ischemic group at day 3 (10.33 ± 2.40 vs. 1.33 ± 0.33, p = 0.021). The percentage of M2 macrophages was higher in the control group than in the ischemic group at day 7 (p<0.05). The levels of inflammatory factors and CXCL12 were higher in the control group than in the ischemic group at the early stage (p = 0.038). CONCLUSIONS Established blood perfusion leads to up-regulation of CXCL12 during adipose tissue repair and regeneration, which may increase recruitment of monocytes to damaged adipose tissue. These findings increase understanding of the cellular events involved in fat graft survival after grafting. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Zijue Wang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, Guangdong,, P. R. China
| | - Yuchen Zhang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, Guangdong,, P. R. China
| | - Yidan Xu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, Guangdong,, P. R. China
| | - Jianqun Cai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Jianhua Gao
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, Guangdong,, P. R. China.
| | - Pan Zhang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, Guangdong,, P. R. China.
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Seth I, Bulloch G, Gibson D, Chow O, Seth N, Mann GB, Hunter-Smith DJ, Rozen WM. Autologous Fat Grafting in Breast Augmentation: A Systematic Review Highlighting the Need for Clinical Caution. Plast Reconstr Surg 2024; 153:527e-538e. [PMID: 37166041 DOI: 10.1097/prs.0000000000010614] [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: 05/12/2023]
Abstract
BACKGROUND Autologous fat grafting (AFG) is a breast augmentation method for treating volume and contour abnormalities. This systematic review aims to summarize complications, radiologic safety, volume retention, and patient satisfaction associated with AFG. METHODS The PubMed, Embase, Google Scholar, Cochrane Central Register of Controlled Trials, Wiley library, clinical key/Elsevier, and EBSCO databases were searched for relevant studies from January of 2009 to March of 2022. Articles describing AFG for breast augmentation were selected based on predetermined inclusion and exclusion criteria. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to, and the study was registered on the International Prospective Register of Systematic Reviews. The Risk of Bias in Nonrandomized Studies of Interventions assessment was used to assess the quality of studies and the risk of bias was measured using the Cochrane Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions. RESULTS A total of 35 studies comprising 3757 women were included. The average follow-up duration was 24.5 months (range, 1 to 372 months). The overall complication rate was 27.8%, with fat necrosis making up 43.7% of all complications. Average fat volume injected was 300 mL (range, 134 to 610 mL), and average volume retention was 58% (range, 44% to 83%). Volume retention was greater with supplementation of fat with platelet-rich plasma and stromal vascular fraction. The most common radiologic changes were fat necrosis (9.4%) and calcification (1.2%). After 1 year of follow-up, patient satisfaction was, on average, 92% (range, 83.2% to 97.5%). The included studies were of good quality and consisted of a moderate risk of bias. CONCLUSIONS AFG was associated with an overall complication rate of 27.8%. Additional supplementation of fat with platelet-rich plasma and stromal vascular fraction may improve graft survival. Despite poor volume retention being a persistent drawback, patient satisfaction remains high.
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Affiliation(s)
- Ishith Seth
- From the Department of Plastic Surgery, Bendigo Health
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre
| | | | - Damien Gibson
- Department of Surgery, Macquarie University Hospital
| | | | - Nimish Seth
- Department of Surgery, University of Melbourne
| | | | - David J Hunter-Smith
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre
| | - Warren M Rozen
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre
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Wederfoort JLM, Hommes JE, Piatkowski A. Reply: Comment on 'Aesthetic Evaluation of Breast Reconstruction with Autologous Fat Transfer Versus Implants'. Aesthetic Plast Surg 2023; 47:2907-2908. [PMID: 36688981 DOI: 10.1007/s00266-023-03249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Jamilla L M Wederfoort
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Juliette E Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Plastic Surgery, VieCuri Medical Center, Venlo, The Netherlands
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Lin Y, Mu D, Zhang X, Li H, Yao Y. Three-Dimensional Volumetric Analysis of the Effect of Interval Time in Autologous Fat Graft Breast Augmentation. Aesthetic Plast Surg 2023; 47:1731-1739. [PMID: 37103526 DOI: 10.1007/s00266-023-03367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Autologous adipose tissue has become increasingly popular in cosmetic and plastic reconstructive surgery, especially breast augmentation surgery. However, the volume retention rate after transplantation significantly varies and may be unsatisfactory. Many patients need two or more autologous fat graft breast augmentations to achieve the expected effect. There are currently no studies on optimal timing between fat injections. METHODS We identified target patients with secondary or multiple autologous fat transplantations by inclusion and exclusion criteria and used three-dimensional scanning technology to calculate the volume retention. Patients were divided into two groups according to the dates of the first and second operations (group A: interoperative time < 120 days, group B: interoperative time ≥ 120 days). We used SPSS 26 for statistical calculations. RESULTS We included 161 patients in this retrospective study, with an average volume retention rate of 36.56% in group A (n = 85) and 27.45% in group B (n = 76). The independent sample t test showed that the volume retention rate in group A was higher than that in group B (P < 0.001). And the paired t test showed there is a significant improvement of volume retention rate after the second fat graft session (P < 0.001). Multivariate regression analysis showed that the interval time was an independent factor affecting the postoperative volume retention rate. CONCLUSION The interval time between autologous fat transplantation for augmentation mammaplasty was an independent factor affecting the postoperative volume retention rate. The postoperative volume retention rate of the < 120 days group was higher than that of the ≥ 120 days group. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yan Lin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Dali Mu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China.
| | - Xiaoyu Zhang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Haoran Li
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Yu Yao
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
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Chai Y, Jia X, Zhu J, Jiang C, Yin N, Li F. Increased Fat Graft Survival by Promoting Adipocyte Dedifferentiation. Aesthet Surg J 2023; 43:NP213-NP222. [PMID: 36415951 DOI: 10.1093/asj/sjac296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Some adipocytes undergo dedifferentiation after fat transplantation, and this may affect the survival of fat grafts. However, this effect has not been adequately studied. OBJECTIVES This study aimed to clarify the effect of promoting the dedifferentiation of mature adipocytes on the survival of fat grafts. METHODS Mature adipocytes and adipose stem cells (ASCs) were treated with OSI-906 (a specific inhibitor of insulin receptor and insulin-like growth factor-1 receptor) in vitro, and then the dedifferentiation of mature adipocytes and the proliferation of ASCs were evaluated. In the in vivo experiment, human lipoaspirates mixed with phosphate-buffered saline (Group A) or OSI-906 (Group B) were compared in nude mice. Grafts were harvested at 2, 8, and 12 weeks, and volume retention rate, histologic, and immunohistochemical analyses were conducted. RESULTS OSI-906 can promote the dedifferentiation of mature adipocytes and inhibit the proliferation of ASCs. At 12 weeks, Group B showed a better volume retention rate (mean [standard deviation, SD], 62.3% [7.61%]) than group A (47.75% [6.11%]) (P < .05). Moreover, viable adipocytes and vascularization showed greater improvement in Group B than in Group A. CONCLUSIONS This study suggests that promoting the dedifferentiation of mature adipocytes can improve the survival rate and quality of fat grafts.
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Affiliation(s)
- Yimeng Chai
- From the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
| | - Xinyu Jia
- From the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
| | - Jinglin Zhu
- From the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
| | - Chanyuan Jiang
- From the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
| | - Ningbei Yin
- From the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
| | - Facheng Li
- From the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing, People's Republic of China
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Li B, Ri C, Mao J, Zhao M. A Bibliometric and Visualization Analysis on the Research of Fat Grafting from 1945 to 2021. Aesthetic Plast Surg 2023; 47:397-411. [PMID: 36261744 DOI: 10.1007/s00266-022-03137-6] [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: 06/18/2022] [Accepted: 10/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND It is very important to generate a comprehensive assessment of the fat grafting field due to the rapid growth of scientific literature. The current study aimed to use bibliometric analysis to evaluate fat grafting research qualitatively and quantitatively and determine the research hotspots and trends in this field. METHODS Publications on fat grafting research were extracted from the Web of Science core collection database. VOSviewer 1.6.18 was applied to perform the bibliometric analysis of these articles. RESULTS A total of 2558 studies published by 594 different journals authored by 9097 researchers were contained in this study. In the co-authorship analysis, the bulk of the retrieved studies was conducted by the USA, followed by China, Italy and Japan, while the most productive institution, journal and author were Chinese Academy of Medicine Sciences, Plastic and Reconstruction Surgery and Klinger M, respectively. In the co-cited analysis, the most top cited author, journal, organization and country were Coleman Sr, Plastic and Reconstruction Surgery, New York University and the USA, respectively. The map of keywords occurrence revealed the most active research aspects were focused on "surgery," "cell," "breast reconstruction" and "survival" and the time overlay mapping showed that the most active research hotspots were "breast reconstruction" and "retention". CONCLUSIONS The research hotspots include the following four aspects: aesthetic surgeries, cell-assisted lipotransfer, breast reconstruction and grafted fat survival. Breast fat grafting and volume retention may be trends in the future. We are willing to provide more beneficial data to contribute valuable research for the fat grafting through this study. 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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Affiliation(s)
- Bo Li
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China
| | - CholSik Ri
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China.,The Pyongyang Medical University in D.P.R of Korea, Pyongyang, Korea
| | - JiaXin Mao
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China
| | - MuXin Zhao
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China.
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Breast Lift Algorithm for the Treatment of Breast Implant Illness Requiring Implant Removal. Aesthetic Plast Surg 2022; 47:934-943. [DOI: 10.1007/s00266-022-03178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/06/2022] [Indexed: 11/24/2022]
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Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Samorani D, Semprini G, Fabiocchi L. Reverse Expansion Following Nipple Sparing Mastectomy: A Natural, Safe and Effective Autologous Technique for Breast Reconstruction. Aesthetic Plast Surg 2022; 46:1602-1608. [PMID: 35064338 DOI: 10.1007/s00266-021-02720-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
The majority of surgeons choose an implant-based breast reconstruction after mastectomy. Nevertheless, lipofilling is a constantly growing technique allowing a complete breast reconstruction without prosthesis. We introduce our experience using reverse expansion for breast reconstruction following a nipple-sparing mastectomy (NSM) with a subpectoral skin expander. In the period January 2010-August 2021, 106 breast reconstruction procedures were performed on 50 patients after a NSM. We harvested an amount of fat tissue using a 2.5 mm liposuction cannula, we centrifuged it 3 min at 4000 rpm and injected in the recipient site using 3 ml syringes and Coleman cannulas. At the beginning of every session, the breast expander was deflated of a saline volume similar to the one of the fat to be injected. We harvested an average of 679.2 ccs of fat per session and injected an average of 319.3 ccs per breast. The mean number of sessions has been 2.4 per breast. The average number of sessions in a radiotreated patients' subgroup has been slightly higher than a control group. The mean follow-up time was 63.5 months and we observed no complications in 105 over 106 procedures. Lipofilling has proven to be a safe and effective technique for complete breast reconstruction. Our procedure considers the use of a breast expander as a device to prepare the recipient site. Reverse expansion after a NSM allows a like-with-like reconstruction and it might be the first reconstructive choice in a selected group of patients.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, AOU Careggi, Largo Piero Palagi 1, 50139, Florence, FI, Italy.
| | - Federico Cattin
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
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11
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Long-Term Clinical and Aesthetic Results of a Systematic Fat Transfer Protocol for Total Breast Reconstruction after Nipple-Sparing Mastectomy. Plast Reconstr Surg 2022; 150:5-15. [PMID: 35499543 DOI: 10.1097/prs.0000000000009251] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Autologous fat transfer can be safely offered for total breast reconstruction after nipple-sparing mastectomy. The aim of this study was to extend a fat transfer protocol to smokers and compare the long-term results among them and irradiated and nonirradiated patients. METHODS One hundred seventeen breasts after nipple-sparing mastectomy were prospectively enrolled and stratified in group A (25 irradiated), group B (21 smokers), or group C (71 controls). A standardized fat transfer protocol was used. Data collected were patient demographics, surgery information, and aesthetic analysis. Continuous and categorical variables were analyzed with the Kruskal-Wallis test, and the Cohen Kappa test was used to test interrater variability for the aesthetic analysis. RESULTS Groups were homogeneous for demographics ( p > 0.05) but significantly different in number of fat transfer sessions ( p < 0.001), mean volume of the first two treatments ( p = 0.003), and mean total volume of injected fat ( p = 0.002). Volume, shape, position of the breast mound, inframammary fold, and scar location subscales obtained high score evaluations without a significant difference among groups ( p > 0.05), whereas skin texture subscale showed a lower score evaluation in group A ( p = 0.003). Although a significant difference for total subscales was worse in group A ( p = 0.004), the global score had a high rate evaluation in all groups ( p = 0.145). Interrater reliability showed substantial agreement among all categories. CONCLUSION Although further investigation is required, the authors confirm the efficacy of their fat transfer protocol for both irradiated and nonirradiated nipple-sparing mastectomy patients and propose its indication to smokers with comparable clinical and aesthetic results. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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12
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The General Registry of Autologous Fat Transfer: Concept, Design, and Analysis of Fat Grafting Complications. Plast Reconstr Surg 2022; 149:1118e-1129e. [PMID: 35404336 DOI: 10.1097/prs.0000000000009162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Society of Plastic Surgeons and The Plastic Surgery Foundation launched GRAFT, the General Registry of Autologous Fat Transfer, in October of 2015. This web-accessible registry addresses the need for prospective and systematic data collection, to determine the rates of unfavorable outcomes (complications) of fat grafting. Understanding and avoiding the factors that lead to complications can help establish safe practices for fat grafting. METHODS Data collected between October of 2015 and November of 2019 were summarized for age, sex, indications, processing techniques, and fat graft volume. Rates of complications for fat grafting to various anatomical areas were calculated. RESULTS The General Registry of Autologous Fat Transfer collected data on 7052 fat grafting procedures from 247 plastic surgery practices. The mean age of the patients in the registry was 51 years (range, 1 to 89 years), 94 percent were female, and 64 percent of the procedures were for aesthetic indications. Whereas the overall complication rate was low (5.01 percent), the complication rates for fat grafting to the breast and buttocks (7.29 percent and 4.19 percent, respectively) were higher than those for face and other areas (1.94 percent and 2.86 percent, respectively). Oil cysts (2.68 percent) and infections (1.64 percent) were the most common complications of breast fat grafting, whereas seroma (1.84 percent) and palpable mass (1.33 percent) were most common for fat grafting to buttocks. Palpable mass (0.54 percent) and infections (0.54 percent) were most common for fat grafting to face. CONCLUSIONS The General Registry of Autologous Fat Transfer provides a valuable tool for prospective tracking of fat grafting techniques and complications. Data collected in the registry show low rates of complications for all recipient areas treated with fat grafting. CLINICAL RELEVANCE STATEMENT GRAFT collects real world data on complications of autologous fat grafting procedures. The data collected over 4 years shows low rates of complications for fat grafting. The benchmarking tools available in GRAFT can help enhance techniques and safety of fat grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Gao Q, Liu C, Qi Z, Zhai P, Qi J, Yang Z, Hu Y, Yuan X. Augmentation Mammoplasty With External Volume Expander-Assisted Autologous Fat Grafting in 305 Asian Patients. Aesthet Surg J 2022; 42:NP407-NP415. [PMID: 35182422 DOI: 10.1093/asj/sjac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND External volume expander (EVE)-assisted autologous fat grafting is suitable for breast augmentation, but no large sample study in Asia has confirmed this method. OBJECTIVES The authors reported their experience and outcomes in augmentation mammoplasty with EVE-assisted autologous fat grafting. METHODS A retrospective study was conducted in 305 female patients who underwent augmentation mammoplasty with EVE-assisted fat grafting between September 2012 and December 2020. Doctors utilized Crisalix (Crisalix S.A., Lausanne, Switzerland) for 3-dimensional (3D) imaging acquisition to measure the increase in breast volume to evaluate doctor satisfaction. The Preoperative Satisfaction with Breast and BREAST-Q questionnaires were employed to assess patients' preoperative and postoperative satisfaction, respectively. RESULTS The 305 female patients were aged 18 to 50 years (mean, 35.9 years). Among them, 68.52% were "very satisfied," 18.69% were "somewhat satisfied," 11.15% were "somewhat dissatisfied," and 1.64% were "very dissatisfied" based on BREAST-Q analysis, whereas 100% were dissatisfied according to the Preoperative Satisfaction with Breast questionnaire. Doctors employed Crisalix to measure the increase in breast volume to evaluate doctor satisfaction. The results showed 76.01% had an increase in breast volume of 150 to 250 mL or >250 mL and were "satisfied" and "very satisfied," respectively, 21.64% had an increase of 50 to 149 mL and were "somewhat satisfied," and 2.30% had an increase <50 mL and were "dissatisfied." There were no complications, such as obvious fat liquefaction, infection, or fat embolism. CONCLUSIONS Augmentation mammoplasty with EVE-assisted fat grafting is effective and satisfying in China. Crisalix for 3D imaging acquisition is convenient and effective in measuring breast volume. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Qiuni Gao
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Zuoliang Qi
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peiming Zhai
- Department of Plastic Surgery, the Fifth People’s Hospital of Hainan Province, Hainan, China
| | - Jun Qi
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenyu Yang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuling Hu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xihang Yuan
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lin J, Zhu S, Liao Y, Liang Z, Quan Y, He Y, Cai J, Lu F. Spontaneous Browning of White Adipose Tissue Improves Angiogenesis and Reduces Macrophage Infiltration After Fat Grafting in Mice. Front Cell Dev Biol 2022; 10:845158. [PMID: 35557960 PMCID: PMC9087586 DOI: 10.3389/fcell.2022.845158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Fat grafting is a frequently used technique; however, its survival/ regeneration mechanism is not fully understood. The browning of white adipocytes, a process initiated in response to external stimuli, is the conversion of white to beige adipocytes. The physiologic significance of the browning of adipocytes following transplantation is unclear. Methods: C57BL/6 mice received 150 mg grafts of inguinal adipose tissue, and then the transplanted fat was harvested and analyzed at different time points to assess the browning process. To verify the role of browning of adipocytes in fat grafting, the recipient mice were allocated to three groups, which were administered CL316243 or SR59230A to stimulate or suppress browning, respectively, or a control group after transplantation. Results: Browning of the grafts was present in the center of each as early as 7 days post-transplantation. The number of beige cells peaked at day 14 and then decreased gradually until they were almost absent at day 90. The activation of browning resulted in superior angiogenesis, higher expression of the pro-angiogenic molecules vascular endothelial growth factor A (VEGF-A) and fibroblast growth factor 21 (FGF21), fewer macrophages, and ultimately better graft survival (Upregulation, 59.17% ± 6.64% vs. Control, 40.33% ± 4.03%, *p < 0.05), whereas the inhibition of browning led to poor angiogenesis, lower expression of VEGF-A, increased inflammatory macrophages, and poor transplant retention at week 10 (Downregulation, 20.67% ± 3.69% vs. Control, 40.33% ± 4.03%, *p < 0.05). Conclusion: The browning of WAT following transplantation improves the survival of fat grafts by the promotion of angiogenesis and reducing macrophage.
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Affiliation(s)
| | | | | | | | | | | | | | - Feng Lu
- *Correspondence: Junrong Cai, ; Feng Lu,
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[Research progress of external volume expansion assisted autologous fat grafting for breast reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:370-375. [PMID: 35293180 PMCID: PMC8923929 DOI: 10.7507/1002-1892.202111016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To review the application progress, mechanism, application points, limitations, and oncological safety of external volume expansion (EVE) assisted autologous fat grafting for breast reconstruction and provide a reference for optimizing the design of EVE. METHODS Based on the latest relevant articles, the basic experiments and clinical applications of EVE were summarized. RESULTS EVE can reduce interstitial fluid pressure, increase blood supply, and promote adipogenic differentiation, thereby benefiting the survival of transplanted fat. EVE assisted autologous fat grafting in clinical practice can improve the retention rate of breast volume and the outcome of breast reconstruction, meanwhile it doesn't increase the risk of local recurrence. But there is no standard parameters for application, and there are many complications and limitations. CONCLUSION EVE improves the survival of transplanted fat, but its complications and poor compliance are obvious, so it is urgent to further investigate customized products for breast reconstruction after breast cancer and establish relevant application guidelines.
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Breast Reconstruction- Developing a Volumetric Outcome Algorithm. Aesthetic Plast Surg 2022; 46:2078-2084. [PMID: 35132459 DOI: 10.1007/s00266-021-02759-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/01/2022]
Abstract
Postoperative loss of breast volume represents a significant parameter for outcome evaluation of breast reconstruction. Breast volume broadly varies- depending of reconstruction method as well as surgical differences. A structural pattern of breast volume loss provides an essential parameter for preoperative design, helps to reduce postoperative breast asymmetry rate and thereby the need for reoperation. Therefore we hereby compare volume change of the three main reconstruction techniques: autologous flap-based, prosthesis-based and autologous fat transplantation breast reconstruction. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Qin Z, Yu Z, Song B. Efficacy and Safety of External Volume Expansion (EVE) on Fat Grafting: A Systematic Review and Single-Arm Meta-Analysis. J Plast Reconstr Aesthet Surg 2021; 75:1073-1082. [PMID: 34930704 DOI: 10.1016/j.bjps.2021.11.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/02/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The autologous fat grafting is commonly used for reconstructive or aesthetic purposes. However, due to the huge variation in methods, its retention rate varies a lot. External volume expansion (EVE) has been used to treat recipient sites of fat grafting. Concerns have been raised regarding its efficacy and safety. METHODS We have searched PubMed, EMBASE, and the Cochrane Library for studies on EVE-assisted fat grafting published from 2000 to 2020. A meta-analysis was conducted to pool the retention rate. The incidence of complications was assessed for reconstructive or aesthetic purposes. RESULTS The 11 included studies involved 1152 patients with operations on 1794 breasts. Four studies were included in the meta-analysis. The pooled retention rate was 65% [95%CI 49, 79]. Eight studies reported the complications. The total complication incidence was 34%, which is 35% for the aesthetic group and 33% for the reconstructive group. The complication rate was not obviously different between the two groups. CONCLUSIONS The study shows that the EVE-assisted fat grafting has better retention rate than traditional fat grafting. However, the data showed that the complication rate was much higher in the EVE-assisted group.
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Affiliation(s)
- Zijin Qin
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, People's Republic of China
| | - Zhou Yu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, People's Republic of China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, People's Republic of China.
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Abboud MH, Kapila AK, Bogaert S, Abboud NM. Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation With Power-Assisted Liposuction and Lipofilling (PALLL). Aesthet Surg J 2021; 41:770-782. [PMID: 33647099 DOI: 10.1093/asj/sjaa327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An increasing number of women wish breast implant removal whilst maintaining an acceptable projection and form were possible. OBJECTIVES The authors propose a technique to remodel the breast after implant removal utilizing internal suture loops to project the breast, recruit abdominal and axillary tissue cranially and medially, and provide a matrix for lipofilling. METHODS A prospective analysis was performed of consecutive patients undergoing implant extraction followed by power-assisted liposuction loops and lipofilling. Patient characteristics were measured. The aesthetic results were evaluated by 2 independent raters. Patient-reported satisfaction was measured by standardized questionnaires. RESULTS Implants in 52 patients with an average age of 55 and body mass index of 23.7 were extracted followed by breast remodeling. A total of 73% of patients had implants for aesthetic reasons, 41% were smokers, and 43% of the reconstruction cases received radiotherapy. A total of 28% had implant extraction for rupture, 58% for capsular contracture, and 14% due to pain and migration. The average volume of the implants removed was 292 cc, followed by an average lipofilling of 223 cc, yielding a ratio of 0.76 to 1. The average tissue recruited by loops was 82.5 cc. Independent raters measured 79% of results as good, 13% as acceptable, and 8% as requiring improvement; 80% of patients were satisfied to very satisfied. CONCLUSIONS The authors propose implant extraction followed by power-assisted liposuction loops and lipofilling can provide footprint definition, sustained projection, and high patient satisfaction. Moreover, the recruitment of a vascularized adipo-cutaneous flap by loops allows a reduced ratio of fat grafting to implant volume. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Marwan H Abboud
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium
| | - Ayush K Kapila
- Plastic and Reconstructive Surgery Department, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Svetlana Bogaert
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium
| | - Nicolas M Abboud
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium
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Abstract
Autologous fat grafting in the setting of breast augmentation and reconstruction has become globally accepted and routinely performed. There is general consensus that small-volume grafting is reproducible and predictable; however, large-volume fat grafting (>100 mL) is less predictable and is not as commonly performed. The aim of this article was to review outcomes following large-volume and megavolume fat grafting in the setting of breast augmentation and reconstruction. Level of Evidence: 4.
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Chen X, Lu F, Yuan Y. The Application and Mechanism of Action of External Volume Expansion in Soft Tissue Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2021; 27:181-197. [PMID: 32821009 DOI: 10.1089/ten.teb.2020.0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Xihang Chen
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
| | - Yi Yuan
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
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Tahseen H, Fayek M, Emara D, Taha AA. Implant to Fat: A Breast Augmentation Technique Validated by BREAST-Q. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2859. [PMID: 33133909 PMCID: PMC7571938 DOI: 10.1097/gox.0000000000002859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Implant-based breast augmentation is the number one cosmetic procedure performed in the United States. However, it is associated with relatively high revision rates, reaching up to 24% at 4 years. This case series presents our experience in implant explantation with simultaneous breast augmentation using fat.
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Affiliation(s)
- Hossam Tahseen
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mina Fayek
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Dawlat Emara
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmed A Taha
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
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Deschler A, Stroumza N, Pessis R, Azuelos A, Atlan M. Primary Breast Augmentation with Autologous Fat Grafting Alone: Evaluation of Patient Satisfaction Using the BREAST-Q. Aesthet Surg J 2020; 40:1196-1204. [PMID: 31912145 DOI: 10.1093/asj/sjz352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Autologous fat grafting (AFG) for primary aesthetic breast augmentation has grown in popularity over recent years but patient satisfaction has never been objectively evaluated. OBJECTIVES The aim of the present study was to use the standardized BREAST-Q questionnaire to evaluate satisfaction in patients who had received primary aesthetic breast augmentation with AFG alone. METHODS All recipients of primary aesthetic breast augmentation by AFG performed between 2013 and 2017 in our plastic surgery department were included. The primary endpoint was assessment of patient satisfaction with the standardized breast augmentation BREAST-Q questionnaire. Three additional questionnaires were used to evaluate patient and surgeon satisfaction. RESULTS In total, 42 patients (84 breasts) underwent breast augmentation by AFG. Mean patient age was 34 years (range, 23-53 years). The mean volume of reinjected fat was 312.2 mL per breast (range, 130-480 mL). We observed significant improvement in all BREAST-Q postoperative items (excluding physical well-being) with a mean increase of 39 points (95% confidence interval: 28.97, 49.03; P < 0.001) regarding patient satisfaction with breasts. Overall, 82% of patients were satisfied with the result of their liposuction. Minor complications were encountered in 6 of our patients (14%). CONCLUSIONS Breast augmentation by AFG enhances patient satisfaction as measured by the BREAST-Q. This procedure has a high satisfaction rate and improves quality of life. Breast augmentation by AFG is a valid surgical option for moderate breast augmentation but is not an alternative to implants in large breast augmentation. Level of Evidence: 4.
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Affiliation(s)
- Alexis Deschler
- Plastic Surgery Department, APHP, Hôpital Tenon, Paris, France
| | | | - Rachel Pessis
- Plastic Surgery Department, APHP, Hôpital Tenon, Paris, France
| | - Arié Azuelos
- Plastic Surgery Department, APHP, Hôpital Tenon, Paris, France
| | - Michael Atlan
- Plastic Surgery Department, APHP, Hôpital Tenon, Paris, France
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Ueberreiter CS, Ueberreiter K, Mohrmann C, Herm J, Herold C. [Long-term evaluation after autologous fat transplantation for breast augmentation]. HANDCHIR MIKROCHIR P 2020; 53:149-158. [PMID: 32777824 DOI: 10.1055/a-1183-4338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background The transplantation of autologous fat is an increasingly common but not standardized procedure in aesthetic and reconstructive surgery. Until now only studies about the short-term results after transplantation with autologous fat have been published. In this publication we present our results of a long-term study after fat transplantation.Patients/Material and Methods 14 patients underwent an MRI investigation which was done before and 5-9 years (mean 6 years) years after aesthetic breast lipofilling according to BEAULI-protocol. The difference in volume was calculated with the open source software OsiriX. Two groups were analyzed separately to calculate the influence of body weight changes in final volume gain. In the first group patients with a stable BMI (increase of less than 1 kg/m2) were included. The second group includes patients with a BMI gain exceeding more than 1 kg/m2. The mean increase in BMI was 1,6 kg/m2 (minimum 0 - maximum 3,9). None of the patients lost weight.Results Depending on the desired amount of breast augmentation the patients underwent between one to four operations. An average of 176 ml fat was transplanted per breast and surgery. In the first group a mean volume survival of 74 % (IQR 58 % - 92 %) was observed. In the second group an increase of 135 % (IQR 105 % - 318 %) of the volume of transplanted fat was observed. After an intermediate weight loss one of the patients regained her initial weight.Conclusion In this study the transplantation of autologous fat renders good long-term results. There is a significant correlation between change of weight and fat transplant volume survival over the years. This also explains the very high increase in breast volume in some patients. Autologous fat transplantation seems to be a safe and efficient method for breast augmentation. For further statements studies with larger number of cases are necessary.
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Affiliation(s)
| | | | - Chris Mohrmann
- Klinikum Oldenburg AöR Anästhesiologie/Intensiv-/Notfallmedizin/Schmerztherapie
| | - Juliane Herm
- Charite Universitatsmedizin Berlin Center for Stroke Research Berlin
| | - Christian Herold
- DIAKO Bremen, Chirurgische Klinik, Sektion Plastische und Ästhetische Chirurgie
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Wang Z, Chen Y, Zhu S, Chen X, Guan J, Yao Y, Wang X, Li Y, Lu F, Gao J, Dong Z. The effects of macrophage‐mediated inflammatory response to the donor site on long‐term retention of a fat graft in the recipient site in a mice model. J Cell Physiol 2020; 235:10012-10023. [DOI: 10.1002/jcp.29816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Zijue Wang
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Yunzi Chen
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Shengqian Zhu
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Xinyao Chen
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Jingyan Guan
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Yao Yao
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Xinhui Wang
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Ye Li
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Jianhua Gao
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
| | - Ziqing Dong
- Department of Plastic and Cosmetic Surgery Southern Medical University Guangzhou Guangdong China
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Davis MJ, Perdanasari AT, Abu-Ghname A, Gonzalez SR, Chamata E, Rammos CK, Winocour SJ. Application of Fat Grafting in Cosmetic Breast Surgery. Semin Plast Surg 2020; 34:24-29. [PMID: 32071576 DOI: 10.1055/s-0039-1700958] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The role of fat grafting to the breasts has evolved in the recent past, gaining several new applications within both reconstructive and aesthetic surgery. Initially used for reconstructive purposes to fill lumpectomy defects or to correct residual contour deformities after breast reconstruction, it has since made its way into cosmetic breast surgery and has grown to encompass a wide variety of new indications. Fat grafting in aesthetic breast surgery may be performed as a form of primary autologous breast augmentation or as an adjunct to implant-based breast augmentation to disguise implant edges. It may also be used to provide added volume after explant surgery or to provide improvements in breast contour alongside mastopexy techniques. In this article, we will review the current applications of fat grafting in aesthetic breast surgery and provide an up-to-date summary of its reported outcomes, safety, and complications.
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Affiliation(s)
- Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Aurelia T Perdanasari
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Santiago R Gonzalez
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward Chamata
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Charalambos K Rammos
- Division of Plastic Surgery, Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois
| | - Sebastian J Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Recipient-Site Preconditioning with Deferoxamine Increases Fat Graft Survival by Inducing VEGF and Neovascularization in a Rat Model. Plast Reconstr Surg 2020; 144:619e-629e. [PMID: 31568298 DOI: 10.1097/prs.0000000000006036] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The authors hypothesize that ischemic preconditioning of the recipient site with deferoxamine will increase fat graft survival by enhancing angiogenesis in a rat model. METHODS Cell viability, tube formation, and mRNA expression were measured in human umbilical vein endothelial cells treated with deferoxamine. A total of 36 rats were then used for an in vivo study. A dose of 100 mg/kg of deferoxamine was injected subcutaneously into the rat scalp every other day for five treatments. On the day after the final injection, the scalp skin was harvested from half the animals to evaluate the effects of deferoxamine on the recipient site. In the remaining animals, inguinal fat tissue was transplanted to the scalp. Eight weeks after transplantation, the grafts were harvested to evaluate the effects of deferoxamine preconditioning on fat graft survival. RESULTS In human umbilical vein endothelial cells, treatment with a deferoxamine concentration higher than 400 μM decreased cell viability compared with the control (p = 0.002). Treatment with 100 and 200 μM deferoxamine increased endothelial tube formation (p = 0.001) and mRNA levels of angiogenesis-related factors (p = 0.02). Rat scalps treated with deferoxamine exhibited increased capillary neoformation (p = 0.001) and vascular endothelial growth factor protein expression (p = 0.024) compared with controls. Fat graft volume retention, capillary density (p < 0.001), and adipocyte viability (p < 0.001) in the grafted fat increased when the recipient site was preconditioned with deferoxamine. CONCLUSION This study demonstrated that recipient site preconditioning with deferoxamine increases fat graft survival by inducing vascular endothelial growth factor and neovascularization.
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Increasing Fat Graft Retention in Irradiated Tissue after Preconditioning with External Volume Expansion. Plast Reconstr Surg 2020; 145:103-112. [DOI: 10.1097/prs.0000000000006372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Discussion: Increasing Fat Graft Retention in Irradiated Tissue after Preconditioning with External Volume Expansion. Plast Reconstr Surg 2019; 145:113-114. [PMID: 31881611 DOI: 10.1097/prs.0000000000006374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Razzouk K, Humbert P, Borens B, Gozzi M, Al Khori N, Pasquier J, Rafii Tabrizi A. Skin trophicity improvement by mechanotherapy for lipofilling‐based breast reconstruction postradiation therapy. Breast J 2019; 26:725-728. [DOI: 10.1111/tbj.13645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Kais Razzouk
- Nice Breast Institute Nice Breast institute Nice France
| | - Philippe Humbert
- Centre d'Etudes et de Recherche sur le Tégument (CERT) INSERM UMR1098 SFR FED 4234 IBCT University of Franche‐Comté Besançon France
| | | | - Marie Gozzi
- Nice Breast Institute Nice Breast institute Nice France
| | - Noor Al Khori
- Department of Diagnostic Imaging Sidra Medicine Doha Qatar
| | | | - Arash Rafii Tabrizi
- Nice Breast Institute Nice Breast institute Nice France
- Weill Cornell Medicine in Qatar Education City Doha Qatar
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Hoon SY, Cui CX, Cao DJ, Hong ZR. Better clinical outcome for autologous fat transplant combined with silicone gel prosthesis for breast augmentation: Evidence from meta-analysis. Asian J Surg 2019; 43:166-180. [PMID: 31648866 DOI: 10.1016/j.asjsur.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/25/2019] [Accepted: 03/04/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the combination of autologous fat transplantation and silicone gel prosthesis implantation for breast augmentation surgery. METHODS With "autologous fat", "silicone prosthesis", "combined with", "combination", "breast augmentation" and "clinical effect" as search keywords, a thorough literature search was performed throughout the Chinese databases (CBMdisc, Wanfang, CNKI and Chongqing VIP) and English databases (PUBMED and EMBASE) and after cross-referencing and reading, literature conforming with the inclusion and exclusion criteria were analyzed and significant data related to autologous fat transplantation combined with silicone prosthesis in breast augmentation surgery was collected and meta-analyzed. RESULTS 21 full-text articles were included into the meta-analysis study: Autologous fat transplantation combined with silicone gel prosthesis implantation not only enhancedthe long-term postoperative breast shape recovery, but also fundamentally managed the underlying drawbacks of using autologous fat graft transplantation or prosthesis alone, decreasing the rate of procedure related morbidity and complications. CONCLUSION The application of the combination of autologous fat transplantation with silicone gel prosthesis implantation in breast augmentation surgery has shown good and stable clinical outcome while simultaneously reducing the rate of complication related to the application of either method alone. Hence, this combination is worth exploration and promotion since it offers better manageable clinical outcome at low risk of complication.
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Affiliation(s)
- Shim Yoong Hoon
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Chun Xiao Cui
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - De Jun Cao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhang Ru Hong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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International Expert Panel Consensus on Fat Grafting of the Breast. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2426. [PMID: 31772879 PMCID: PMC6846285 DOI: 10.1097/gox.0000000000002426] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/02/2019] [Indexed: 12/24/2022]
Abstract
Background Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the authors of this study have organized a Survey and an International Consensus Conference that was held at the Aesthetic Breast Meeting in Milan (December 15, 2018). Methods All studies on fat grafting, both for breast aesthetic and reconstructive purposes, were electronically screened. The literature review led to 17 "key questions" that were used for the Survey. The authors prepared a set of 10 "key statements" that have been discussed in a dedicated face-to-face session during the meeting. Results The 10 key statements addressed all the most debated topics on fat grafting of the breast. Levels of evidence for the key statements ranged from III to IV with 2 statements (20%) supported by a level of evidence III and 6 statements (60%) by level of evidence IV. Overall consensus was reached for 2 statements (20%) with >75% agreement reached for 7 statements. Conclusions The survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.
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Autogenous Fat Grafting to the Breast and Gluteal Regions: Safety Profile Including Risks and Complications. Plast Reconstr Surg 2019; 143:1625-1632. [PMID: 31136476 DOI: 10.1097/prs.0000000000005617] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Given the widespread utility and therapeutic potential of autogenous fat grafting, plastic surgeons should be familiar with its safety profile and associated adverse events. This article provides a critical review of the literature and delineates risk factors associated with various complications when grafting to the breast and gluteal regions. The majority of adverse events are related to fat necrosis and require minimal diagnostic or therapeutic intervention. Larger graft volumes, as in cosmetic augmentation, are associated with higher incidences of fatty necrosis. The oncologic safety of fat grafting is supported by multiple clinical studies with thousands of breast cancer patients, albeit predominantly retrospective in nature. Although less frequent, serious complications include fat emboli during gluteal augmentation. Identification of associated risk factors and implementation of proper surgical techniques may minimize the occurrence of life-threatening complications.
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Wang CL, Luan SS, Panayi AC, Xin MQ, Luan J. Methods used for evaluation of volume retention rate in autologous fat grafting for breast augmentation: a systematic review. Chin Med J (Engl) 2019; 132:2223-2228. [PMID: 31490259 PMCID: PMC6797153 DOI: 10.1097/cm9.0000000000000415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Autologous fat grafting has gained popularity in breast augmentation. Various methods can be used to estimate the volume retention rate. This systematic review aimed to establish whether the type of method used for measuring breast volume is a factor that influences the reported volume retention rate. METHODS Studies were identified using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception of the database up to February 2019. Articles describing autologous fat grafting for breast augmentation were selected based on pre-determined inclusion and exclusion criteria. The characteristics of the included studies were summarized, and the reported volume retention rate from the studies was compared. A quality assessment of all included articles was performed using the methodological index for non-randomized studies criteria. RESULTS A total of 618 articles were identified, of which 12 studies, with a total of 1337 cases, were eligible. The retention rate of injected adipose tissue varied when the method of fat grafting and volume analysis used were both the same, as well as when the method of fat grafting was the same but the method of volumetric evaluation used was different. CONCLUSIONS Currently, the tools available for estimating the volume retention rate come with limitations. In order to objectively evaluate the percentage of graft retention, a standard protocol that applies to the different methods should be established in the future.
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Affiliation(s)
- Cheng-Long Wang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Si-Si Luan
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Adriana C. Panayi
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Min-Qiang Xin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Jie Luan
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
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Efficacy of an external volume expansion device and autologous fat grafting for breast reconstruction following breast conserving surgery and total mastectomy: Small improvements in quality of life found in a prospective cohort study. J Plast Reconstr Aesthet Surg 2019; 73:27-35. [PMID: 31495743 DOI: 10.1016/j.bjps.2019.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 07/06/2019] [Accepted: 07/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although autologous fat grafting (AFG) for breast reconstruction is feasible, the best methods have yet to be established. This study aimed to assess the efficacy of fat grafting using an external expansion device for complete breast reconstruction post breast cancer surgery hypothesizing that it would improve quality of life. METHODS A prospective cohort study was conducted in women who had undergone breast cancer surgery and complete reconstruction using AFG. An external expansion device was used previously (as per Miami protocol) to a single-stage AFG. Quality of life outcomes were determined using the validated BREAST-Q questionnaire, and 3D laser and magnetic resonance imaging scan were used to measure fat graft retention. RESULTS Twenty-six participants were recruited, with seven withdrawing. The remaining 19 women were compliant with external expander use. The mean volume of AFG was 270.4 mL (98-490 mL) with a mean of 48.8% retained at 12 months following injection. Symmetry improved but did not meet the acceptable symmetry ratio of 0.8. Nine patients (47.3%) noted increased skin elasticity and softening of areas of scarring. Skin irritation occurred in 11 out of 19 patients. Mean BREAST-Q scores improved significantly in the domains of satisfaction with breast (40 vs. 49, p < 0.001), psychosocial well-being (55 vs. 68, p < 0.001), physical well-being abdomen (73 vs. 87, p < 0.001), and sexual well-being (41 vs, 48, p < 0.001). CONCLUSION Improved quality of life and breast volume increase were achieved following external expansion and AFG. However, breast fat engraftment retention was similar to that reported in previous studies using fat grafting alone.
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Kwiatkowska K, Krapohl BD, Tanzella U, Ueberreiter K. Long-term clinical results and quality of life in patients undergoing autologous fat transplantation for breast augmentation using the BEAULI™ protocol. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2019; 8:Doc10. [PMID: 31275800 PMCID: PMC6545491 DOI: 10.3205/iprs000136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Autologous fat transplantation for breast augmentation has become increasingly interesting for patients and surgeons but only a few standardized procedures are available. BEAULI™ (Berlin Autologous Lipotransfer) protocol provides a suitable method with a standardized protocol. The aim of the study was to trace the 5-year long-term results after breast enlargement using the BEAULI™ protocol and the determination of changes in quality of life in relation to the intervention. Patients and methods: The study included non-smoking, currently non-pregnant women from the first BEAULI™ study (2007-2010), who were operated only for aesthetic reasons. BMI values, the jugulum nipple distance (JND), the breast base, and the maximum breast circumference were determined. The patients answered also a questionnaire with 30 questions on the postoperative quality of life. Results: The results measured after 6 months remained constant over 5 years. There was an average increase of the JND by 1.8 cm or 9.5%, and a widening of the base by 1.2 cm or 8.8%, and of breast circumference by 4.4 cm or 24%. The patients' quality of life, especially self-confidence and acceptance of their own body, has improved significantly after the operation. Discussion: The satisfying 5-year long-term results and low complication rate are two big advantages of the BEAULI™ method. The option to use autologous fat transplantation for another purpose like for reconstruction of breasts after a mastectomy increases the attractiveness of this method. Conclusions: Fat transplantation for breast enlargement using BEAULI™ is a high-quality method with good results, and it is an alternative to silicone implants or other autologous tissue transplantations. Patients are satisfied with the BEAULI™ protocol, the complication rate is small, and natural results are achieved with moderate scars.
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Affiliation(s)
- Katarzyna Kwiatkowska
- Park-Klinik-Birkenwerder, Private Clinic for Plastic and Aesthetic Surgery, Birkenwerder, Germany
| | - Björn Dirk Krapohl
- Plastic and Reconstructive Surgery, Carl-Thiem-Klinikum, Cottbus, Germany
| | - Ursula Tanzella
- Park-Klinik-Birkenwerder, Private Clinic for Plastic and Aesthetic Surgery, Birkenwerder, Germany
| | - Klaus Ueberreiter
- Park-Klinik-Birkenwerder, Private Clinic for Plastic and Aesthetic Surgery, Birkenwerder, Germany
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Platelet-Rich Plasma and Platelet-Rich Fibrin Enhance the Outcomes of Fat Grafting. Plast Reconstr Surg 2019; 143:1201e-1212e. [DOI: 10.1097/prs.0000000000005624] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fat Grafting into Younger Recipients Improves Volume Retention in an Animal Model. Plast Reconstr Surg 2019; 143:1067-1075. [PMID: 30730498 DOI: 10.1097/prs.0000000000005483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Soft-tissue deficits associated with various craniofacial anomalies can be addressed by fat grafting, although outcomes remain unpredictable. Furthermore, consensus does not exist for timing of these procedures. Whereas some advocate approaching soft-tissue reconstruction after the underlying skeletal foundation has been corrected, other studies have suggested that earlier grafting may exploit a younger recipient niche that is more conducive to fat graft survival. As there is a dearth of research investigating effects of recipient age on fat graft volume retention, this study compared the effectiveness of fat grafting in younger versus older animals through a longitudinal, in vivo analysis. METHODS Human lipoaspirate from three healthy female donors was grafted subcutaneously over the calvaria of immunocompromised mice. Volume retention over 8 weeks was evaluated using micro-computed tomography at three experimental ages: 3 weeks, 6 months, and 1 year. Histologic examination was performed on explanted grafts to evaluate graft health and vascularity. Recipient-site vascularity was also evaluated by confocal microscopy. RESULTS The greatest retention of fat graft volume was noted in the youngest group compared with both older groups (p < 0.05) at 6 and 8 weeks after grafting. Histologic and immunohistochemical analyses revealed that improved retention in younger groups was associated with greater fat graft integrity and more robust vascularization. CONCLUSION The authors' study provides evidence that grafting fat into a younger recipient site correlates with improved volume retention over time, suggesting that beginning soft-tissue reconstruction with fat grafting in patients at an earlier age may be preferable to late correction.
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The Preparation of the Recipient Site in Fat Grafting: A Comprehensive Review of the Preclinical Evidence. Plast Reconstr Surg 2019; 143:1099-1107. [PMID: 30921129 DOI: 10.1097/prs.0000000000005403] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Several methods to prepare the recipient site in fat grafting have been proposed in recent decades. However, to date, these procedures have never been reviewed exhaustively. The purpose of the present study is to provide a comprehensive overview of the different techniques to prepare the recipient site for fat grafting as they were investigated in preclinical studies, with resulting outcomes and underlying mechanisms of action. METHODS The PubMed/MEDLINE database was queried to search for preclinical investigations on the preparation of the recipient site in fat grafting using the following algorithm: ((recipient site) AND (fat grafting) OR (lipofilling) OR (lipograft)). A priori criteria were applied to review the resulting articles. RESULTS Thirteen animal studies met inclusion criteria. Overall, five techniques were identified: external volume expansion, implantation of alloplastic material (silicone sheets), administration of cell-proliferation factors (i.e., vascular endothelial growth factor, adipose tissue-derived stromal vascular fraction, and interleukin-8), ischemia, and microneedling. A positive effect on cellular activity (cell proliferation and angiogenesis) was demonstrated by all studies and achieved with all techniques. Seven of the eight authors who examined this aspect reported enhancement of fat graft survival. CONCLUSIONS Improvement of fat grafting surgical outcomes is documented preclinically using different recipient-site preparation techniques, particularly through enhancement of vascularization and soft-tissue expansion. This understanding will lead to further clinical research, especially for those cases where improvement of the recipient site is recommended, such as contracted scars or preirradiated tissues.
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Discussion: The Preparation of the Recipient Site in Fat Grafting: A Comprehensive Review of the Preclinical Evidence. Plast Reconstr Surg 2019; 143:1108-1110. [PMID: 30921130 DOI: 10.1097/prs.0000000000005404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Farber SE, Minteer D, Gusenoff BR, Gusenoff JA. The Influence of Fat Grafting on Skin Quality in Cosmetic Foot Grafting: A Randomized, Cross-Over Clinical Trial. Aesthet Surg J 2019; 39:405-412. [PMID: 30007274 DOI: 10.1093/asj/sjy168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pedal fat grafting is a cosmetic procedure to treat the functional and aesthetic sequelae of pedal fat pad atrophy. Fat grafting has been found to mitigate these symptoms, but the exact mechanism is unknown. OBJECTIVES The authors hypothesized that pedal fat grafting may improve skin quality, accounting for prolonged symptomatic improvement despite loss of grafted fat. METHODS Patients with pedal atrophy were enrolled in a randomized crossover clinical trial. Group 1 underwent fat grafting upon enrollment with 2-year follow-up. Group 2 was managed conservatively for 1 year then placed into the fat grafting group with 1-year follow-up. Patients underwent pedal ultrasounds to determine thicknesses of the fat pad and dermis, and photographs were taken to assess skin quality. RESULTS Three men and 20 women with an average age of 63 ± 6 years and an average BMI of 26.0 ± 4.6 kg/m2 were enrolled in the study. Twenty-six feet were injected in Group 1 and 17 were injected in Group 2. Group 1 dermal thickness increased at 6 months post-injection (P < 0.05). This increase persisted through 24 months. Group 2 dermal thickness decreased prior to injection (P < 0.05) but returned to baseline after injection and through 12-month follow-up (P < 0.05). Fat pad thickness returned to baseline by study completion in both groups (P < 0.05). CONCLUSIONS Pedal fat grafting yielded a significant, sustained increase in dermal thickness, though grafted fat was not retained. Fat grafting may improve skin quality, which could contribute to improved clinical outcomes despite loss of grafted fat. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Stephanie E Farber
- Department of Plastic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Danielle Minteer
- Department of Plastic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Beth R Gusenoff
- Department of Plastic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jeffrey A Gusenoff
- Department of Plastic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA
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Kim YW, Min HJ, Choi RJ, Lee DH, Cheon YW. Insulin Promotes Adipose-Derived Stem Cell Differentiation after Fat Grafting. Plast Reconstr Surg 2019; 142:927-938. [PMID: 29979369 DOI: 10.1097/prs.0000000000004814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adipose-derived stem cells are used to enhance fat graft survival. However, their mechanism of action when grafted is controversial. The grafted cells can be replaced by connective tissue or survive at the recipient site and differentiate. Insulin is a powerful agent used to induce their differentiation to adipocytes. The purpose of this study was to elucidate the fate of grafted adipose-derived stem cells in nonvascularized fat grafts with or without insulin. METHODS Fat was harvested from a female human donor who had undergone reduction mammaplasty. The authors also isolated and cultured adipose-derived stem cells expressing green fluorescent protein from transgenic Sprague-Dawley rats. Injection of free fat graft, the adipose-derived stem cells, phosphate-buffered saline, and insulin was performed on the four paravertebral points of the back of each mouse (n = 30) as follows: group A (control group) received adipose tissue and phosphate-buffered saline; group B received adipose tissue and adipose-derived stem cells; group C received adipose tissue, adipose-derived stem cells, and phosphate-buffered saline; and group D received adipose tissue, adipose-derived stem cells, and insulin. Green fluorescent protein expression was evaluated using an in vivo imaging system. The volume of transplanted fat was evaluated at 8 weeks after graft with six histologic parameters. The fat graft was immunostained with green fluorescent protein, 4',6-diamidino-2-phenylindole, and perilipin. Statistical analysis was performed using a one-way analysis of variance test. RESULTS The fat graft volume was significantly higher in group D (p < 0.05). Histologic examination revealed reduced fibrosis and increased cysts, vacuoles, integrity, and vascularity in group D. The green fluorescent protein and perilipin co-positive area was more apparent in group D compared with groups B and C. CONCLUSION Insulin could enhance the survival and differentiation of adipose-derived stem cells in nonvascularized fat grafts.
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Affiliation(s)
- Yang Woo Kim
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine; and the Lamiche Plastic Surgery Clinic
| | - Hyung Jun Min
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine; and the Lamiche Plastic Surgery Clinic
| | - Rak Jun Choi
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine; and the Lamiche Plastic Surgery Clinic
| | - Dong Hun Lee
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine; and the Lamiche Plastic Surgery Clinic
| | - Young Woo Cheon
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine; and the Lamiche Plastic Surgery Clinic
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Delayed Postconditioning with External Volume Expansion Improves Survival of Adipose Tissue Grafts in a Murine Model. Plast Reconstr Surg 2019; 143:99e-110e. [DOI: 10.1097/prs.0000000000005167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Discussion: Enhancement of Progenitor Cells by Two-Step Centrifugation of Emulsified Lipoaspirates. Plast Reconstr Surg 2018; 142:110-111. [PMID: 29952892 DOI: 10.1097/prs.0000000000004529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim JB, Jin HB, Son JH, Chung JH. For Better Fat Graft Outcome in Soft Tissue Augmentation: Systematic Review and Meta-Analysis. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2018. [DOI: 10.14730/aaps.2018.24.3.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Improved Long-Term Volume Retention of Stromal Vascular Fraction Gel Grafting with Enhanced Angiogenesis and Adipogenesis. Plast Reconstr Surg 2018; 141:676e-686e. [PMID: 29334574 DOI: 10.1097/prs.0000000000004312] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The apoptosis of mature adipocytes after fat grafting can result in chronic inflammation, absorption, and fibrosis, leading to unpredictable outcomes. Selective elimination of mature adipocytes may result in better outcomes and a different underlying retention mode. The authors previously developed a mature adipocyte-free product, stromal vascular fraction gel, derived from lipoaspirate, which eliminates adipocytes and preserves the stromal vascular fraction. This study investigated the retention and regeneration mode of stromal vascular fraction gel grafting. METHODS Nude mice were grafted with human-derived stromal vascular fraction gel or Coleman fat. Detailed cellular events over 3 months were investigated histologically and immunohistochemically. RESULTS The retention rate 90 days after grafting was significantly higher for stromal vascular fraction gel grafts than for standard Coleman fat (82 ± 15 percent versus 42 ± 9 percent; p < 0.05). Histologic analysis suggested that, unlike Coleman fat grafts, stromal vascular fraction gel grafts did not include significant necrotic areas. Moreover, although adipose tissue regeneration was found in grafts of both groups, rapid angiogenesis and macrophage infiltration were observed at a very early stage after stromal vascular fraction gel grafting. The presence of small preadipocytes with multiple intracellular lipid droplets in stromal vascular fraction gel grafts on day 3 also suggested very early adipogenesis. Although some of the cells in the stromal vascular fraction survived in stromal vascular fraction gel grafts, most of the newly formed adipose tissue was host-derived. CONCLUSION Stromal vascular fraction gel has a high long-term retention rate and a unique adipose regeneration mode, involving prompt inflammation and infiltration of immune cells, stimulating rapid angiogenesis and inducing host cell-mediated adipogenesis.
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Fate of Free Fat Grafts with or without Adipogenic Adjuncts to Enhance Graft Outcomes. Plast Reconstr Surg 2018; 142:939-950. [DOI: 10.1097/prs.0000000000004739] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Engels PE, Kappos EA, Sieber PK, Benz RM, Thommen S, Schaefer DJ, Kalbermatten DF. From Bedside to Bench: The Effect of Muscular Denervation on Fat Grafting to the Breast by Comparing Take Rate, Quality, and Longevity. Aesthet Surg J 2018; 38:900-910. [PMID: 29596609 DOI: 10.1093/asj/sjy073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Autologous fat grafting (AFG) to the breast is a frequent procedure in aesthetic and reconstructive surgery. Despite pure volume gain, questions remain regarding the engraftment rate, quality, and longevity. Little is known about the role of recipient tissue or innervation of the grafted area. OBJECTIVES The goal of this study was to determine the optimal recipient layer and muscular pretreatment of AFG. METHODS Fat was grafted to the breast, pectoralis muscle, or adjacent subcutaneous tissue of 42 rats. Nerve treatment included excision of a nerve segment, botulinum toxin (BTX) injection, or no treatment. Magnetic resonance imaging (MRI) and histological workup were carried out after 2 and 6 weeks. RESULTS Six weeks after AFG, the proportion of viable fat cells within the grafted fat stayed high (median, [IQR]: 81% [72% to 85%]). The signs of inflammation decreased over time. Intramuscular grafting with intact nerves had a decreasing effect on the viability of the grafted cells compared with subcutaneous treatment (-10.21%; 95% confidence interval [-21.1 to 0.68]). CONCLUSIONS If utilized on an intact nerve, intramuscular injection may lead to inferior results. If the nerve was cut or treated with BTX; however, intramuscular injection tends to be superior. These findings may prove interesting for future studies and eventual clinical application.
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The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1649. [PMID: 29616164 PMCID: PMC5865941 DOI: 10.1097/gox.0000000000001649] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 01/29/2023]
Abstract
Background: The fat grafting process includes the 4 phases of tissue harvesting, processing, recipient-site preparation, and reinjection. Among them, the preparation of the recipient site has never been exhaustively reviewed. We aim to provide a comprehensive overview of the methods to prepare the recipient site through external expansion with the resulting outcomes. Methods: PubMed/Medline database was searched for studies on fat grafting recipient site preparation by applying the following algorithm: ((fat grafting) OR (lipofilling) OR (lipograft) AND (recipient site)). A priori criteria were used to review the resulting articles and identify those dealing with external expansion. Results: Fourteen studies published from 2008 through 2016 met inclusion criteria (4 case reports, 6 retrospective, and 4 prospective studies), representing 1,274 treated patients. Two devices for preexpansion were used with different protocols: BRAVA system and Kiwi VAC-6000M with a PalmPump. The 13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeon. Conclusions: External expansion and fat grafting is a promising technique for breast reconstruction and augmentation. However, due to the overall low level of evidence of the available studies, further research is needed to validate the procedure.
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