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Rupra RS, Daneshi K, Liyanage D, Ceccaroni A, Gentile A, Khajuria A. Publication Trends in Aesthetic Breast Surgery: A Bibliometric Analysis. Aesthet Surg J Open Forum 2024; 6:ojae045. [PMID: 39015114 PMCID: PMC11249954 DOI: 10.1093/asjof/ojae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
Background Aesthetic breast surgery (ABS) encompasses breast augmentation, breast reduction, mastopexy, and mastopexy augmentation. This topic has seldom been assessed as a bibliometric study. This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. Bibliometrics, the quantitative analysis of publications, particularly scholarly literature, offers valuable insights into research trends and impact. Objectives This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. Methods The 100 most-cited publications in ABS were identified on Web of Science (Clarivate Analytics, Philadelphia, PA), across all available journal years (from 1953 to 2024). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. The Oxford Centre for Evidence Based Medicine and levels of evidence (LOE) of each study were assessed. Results The 100 most-cited publications in ABS were cited by a total of 11,522 publications. Citations per publication ranged from 46 to 1211 (mean 115.2 ± 135.7), with the highest-cited study being the Pusic BREAST-Q paper (n = 1211). A majority of publications were LOE 4 (n = 30), representative of the large number of case series. The number of publications for LOE 5, 3, 2, and 1 was 12, 28, 21, and 9, respectively. The main content focus was "outcomes" in 52 publications, followed by "nonoperative management" (n = 12) and "surgical technique" (n = 12). Patient-reported outcome measures (PROMs) were used in 29 publications, and 53 publications reported aesthetic outcome measures. Conclusions This analysis highlights that research methodologies in ABS studies should be improved. This necessary improvement would be facilitated by vigorous, high-quality research, and the implementation of validated ABS-specific PROMs enhancing patient satisfaction, particularly in aesthetic procedures, such as BREAST-Q. Level of Evidence 4
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Affiliation(s)
| | | | | | | | | | - Ankur Khajuria
- Corresponding Author: Dr Ankur Khajuria, Ayrton Rd, South Kensington, London SW7 5NH, UK. E-mail: ; Twitter (X): @akhajuria1
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Bayraktar HS, Okyay MF. Effects of Oleuropein Oral Intake on Infected Fat Grafts: Experimental Study. Aesthetic Plast Surg 2024; 48:1218-1228. [PMID: 37658188 DOI: 10.1007/s00266-023-03612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/13/2023] [Indexed: 09/03/2023]
Abstract
AIM The aim of this study was to evaluate the effects of oleuropein oral intake on infected fat grafts and fat graft survival. MATERIALS AND METHODS 32 Wistar albino rats were divided into four groups: 0. none treated, 1. serum oral intake, 2. antibiotic oral intake, and 3. oleuropein oral intake. The dorsal regions of the rats were separated into four quadrants as right and left cranial, and right and left caudal to determine each quadrant where fat grafts were placed. Right cranial and caudal quadrants were infected with the methicillin-susceptible Staphylococcus aureus (MSSA) strain. The left cranial and caudal quadrants were infected with the Pseudomonas aeruginosa strain. On the 7th day and end of the 3rd month, fibroblast density, inflammation, and fat survival were demonstrated immunohistochemically with FGF, CD68, and perilipin (PP), respectively. RESULTS On the 7th day, for P. aureginosa-infected grafts, oleuropein was shown higher rates in CD68 and PP staining compared to the antibiotic group (p < 0.05, p < 0.001, respectively). At the end of the 3rd month, for P. aureginosa and S. aureus-infected grafts, the oleuropein group was demonstrated improved PP staining rates compared to the antibiotic group (p < 0.01, p < 0.01, respectively). CONCLUSION Oleuropein as a natural olive leaf extract with potent antioxidant, anti-inflammatory, and antimicrobial features is an alternative and supportive agent for both treatment and prophylaxis of surgical site infections like the antibiotics of chemical synthesis. P. aeruginosa and S. aureus surgical site infections could treat and prevent safely and effectively by oleuropein, particularly in early and late periods after surgery. 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)
- Hamdullah Suphi Bayraktar
- Hatay Mustafa Kemal University Experimental Research Application and Research Center, 31000, Hatay, Turkey.
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Brau-Javier CN, Caro-Muniz AP, Canizares O. Facial fat necrosis after autologous fat transfer possibly associated with SARS-CoV-2 vaccine. J Cosmet Dermatol 2023; 22:1477-1480. [PMID: 36891961 DOI: 10.1111/jocd.15635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/03/2023] [Indexed: 03/10/2023]
Abstract
A 52-year-old female patient developed facial fat necrosis presenting with cutaneous induration three weeks after minimal access cranial suspension (MACS) lift with autologous fat grafting from the abdomen. Given that the patient received the Moderna SARS-CoV-2 vaccine one week after surgery, we hypothesize that the former predisposed her to tissue ischemia leading to fat necrosis. Histological findings after biopsy were consistent with fat necrosis, which included marked dermal fibrosis with areas of focal fat necrosis, lipophages, multinucleated giant cells, and siderophages. It is our hope that documenting this rare development in literature may serve as encouragement for adverse effect reporting after the SARS-CoV-2 vaccine administration and may boost inspection and monitoring of other health consequences by regulating agencies.
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Affiliation(s)
- Cristina N Brau-Javier
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Zhou F, Zhang J, Gong L, Wang G, Khan A, Cui H. Infection caused by Lawsonella clevelandensis after breast augmentation with autologous fat grafting: a case report. BMC Infect Dis 2023; 23:124. [PMID: 36855087 PMCID: PMC9976391 DOI: 10.1186/s12879-022-07812-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 10/26/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Lawsonella clevelandensis is one recently documented anaerobic, which is partially acid-fast. Nevertheless, it is rarely found to be associated with human infections, especially in scope of plastic and cosmetic surgery before our patient who was performed breast augmentation with autologous fat grafting. Breast augmentation is becoming popular, the most common post-surgery complication of which is bacterial infection. CASE PRESENTATION A 29-year-old female who was found swelling in her right breast and fever after breast augmentation surgery with autologous fat grafting was administered. Before administration, she had been treated with antibiotics (details unknown) for more than 1 month without any significant improvements. After administration, she was treated with intravenous antibiotic empirically and repeated debridement via Vaccuum Sealing Drainage (VSD). And samples of the necrotic tissues and pus collected in surgery were sent for microbiological testing. However, routine examination failed. Thus samples were further collected and sent to Genoxor Medical & Science Technology Inc. (Shanghai, China) to conduct Next-Generation Sequencing (NGS). Surprisingly Lawsonella clevelandensis was determined. Accordingly, sensitive antibiotic was applied in concert with thorough debridement and drainage and finally her condition was completely reversed with wound closure gradually. CONCLUSION Complications of breast augmentation with autologous fat graft are various, of which infection is most common. Rare pathogen such as Lawsonella clevelandensis infection in human is rare in clinical practice. Moreover, it is difficult to differentiate from non-tuberculous mycobacterium for its partial acid resistance, difficulty to culture and abscess formation. How to determine diagnosis of Lawsonella clevelandensis infection accurately come to be critical In our report, NGS is recommended as a useful method to identify the pathogen, which may provide us a novel tool for refractory wound.
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Affiliation(s)
- Feng Zhou
- grid.412793.a0000 0004 1799 5032Department of Plastic and Aesthetic Surgery, Tongji Hospital Affiliated to Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200065 China
| | - Jun Zhang
- grid.412793.a0000 0004 1799 5032Department of Plastic and Aesthetic Surgery, Tongji Hospital Affiliated to Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200065 China
| | - Lunli Gong
- grid.412793.a0000 0004 1799 5032Department of Plastic and Aesthetic Surgery, Tongji Hospital Affiliated to Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200065 China
| | - Guobao Wang
- grid.412793.a0000 0004 1799 5032Department of Plastic and Aesthetic Surgery, Tongji Hospital Affiliated to Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200065 China
| | - Aawrish Khan
- grid.412793.a0000 0004 1799 5032Department of Plastic and Aesthetic Surgery, Tongji Hospital Affiliated to Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200065 China
| | - Haiyan Cui
- Department of Plastic and Aesthetic Surgery, Tongji Hospital Affiliated to Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200065, China.
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An Y, Wang G, Shang Y, Zhen Y, Li X, Shu F, Li D, Zhao Z, Li H. Autologous Shuffling Lipo-Aspirated Fat Combined Mechanical Stretch in Revision Rhinoplasty for Severe Contractures in Asian Patients. Aesthetic Plast Surg 2023; 47:282-291. [PMID: 35606536 DOI: 10.1007/s00266-022-02920-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A severely contracted nose is a common occurrence. Intraoperative expansion is not sufficient to soften the severely constricted nasal envelope, which poses challenges in revision rhinoplasty. In recent years, adjuvant therapies, including nasal fat grafting and cell component injection, are applied before revision rhinoplasty to soften the nasal envelope. Herein, autologous shuffling lipo-aspirated fat and manual mechanical stretch were combined as adjuvant therapy before revision rhinoplasty. METHODS A total of 24 patients with severe nasal contracture were included in this study. Of these, 8 received autologous shuffling lipo-aspirated fat and manual mechanical stretch before revision rhinoplasty (comprehensive therapy), 8 underwent mechanical stretch and revision rhinoplasty, and 8 patients underwent only revision rhinoplasty. The objective and subjective outcome assessment was processed in the follow-up period of 6 months. Nasal length, nasal tip projection, nasofrontal angle, and nasolabial angle were measured, and potential complications were assessed. RESULTS All 24 patients underwent a successful revision rhinoplasty. In the comprehensive therapy group, no patient had postoperative wound infection and defect of the nasal column mucous. The comprehensive treatment group had the most significant improvement in nasal length and nasal tip projection, and the nasolabial angle was the closest to 90°, which indicated the most effective nasal revision and aesthetic contour. CONCLUSIONS The adjuvant therapy combines autologous shuffling lipo-aspirated fat and manual mechanical stretch before revision rhinoplasty could effectively improve the surgical outcome and decrease the postoperative complications regarding severe nasal contractures. 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)
- Yang An
- Department of Plastic Surgery, Peking University 3rd Hospital, NO.49 of North Huayuan Road, Haidian District, Beijing, 100191, China.
| | - Guanhuier Wang
- Department of Plastic Surgery, Peking University 3rd Hospital, NO.49 of North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Yujia Shang
- Department of Plastic Surgery, Peking University 3rd Hospital, NO.49 of North Huayuan Road, Haidian District, Beijing, 100191, China
- Department of Natural Products Chemistry, School of Traditional Chinese Materia Medica, Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Yonghuan Zhen
- Department of Plastic Surgery, Peking University 3rd Hospital, NO.49 of North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Xiao Li
- Department of Plastic Surgery, Peking University 3rd Hospital, NO.49 of North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Fan Shu
- Department of Plastic Surgery, Peking University 3rd Hospital, NO.49 of North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Dong Li
- Department of Plastic Surgery, Peking University 3rd Hospital, NO.49 of North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Zhenmin Zhao
- Department of Plastic Surgery, Peking University 3rd Hospital, NO.49 of North Huayuan Road, Haidian District, Beijing, 100191, China
| | - Hua Li
- Department of Natural Products Chemistry, School of Traditional Chinese Materia Medica, Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, 110016, China.
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Primary Breast Augmentation with Fat Grafting. Clin Plast Surg 2022. [DOI: 10.1016/j.cps.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yin B, Zhang X, Cai L, Han X, Li F. Function-preserving fat grafting in the breast: Results based on 18 years of experience. J Plast Reconstr Aesthet Surg 2022; 75:2996-3003. [PMID: 35853805 DOI: 10.1016/j.bjps.2022.04.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 02/27/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Autologous fat transplantation has been used for breast nearly 40 years, but there are two main problems: the volume retention rate is unpredictable, leading to too many operations, and various complications, such as nodules, necrosis and calcification, occur. OBJECTIVE The author proposed "function-preserving fat grafting" (FPFG) and reviewed the clinical data of patients from October 2002 to December 2020. METHODS A total of 1218 patients underwent surgery, and 767 patients were followed up for more than half a year. Their ages ranged from 22 to 61 (31.9±10.1) years, and the BMI values ranged from 16.1 to 28.2 (20.6±2.73) kg/m2. Group I included 703 cases of breast aesthetic augmentation, group II included 38 cases of breast reconstruction after mastectomy (10 cases after radiotherapy and 7 cases after the Brava device was worn) and group III included 26 cases of simultaneous implant exchange with fat. RESULTS At 6 months after the operation, 89.8% of the patients were satisfied with the outcome. For these patients, aesthetic augmentation required 1.9±0.73 procedures, and the unilateral breast injection volume was 180-380 ml (265.5±46.6); breast reconstruction required an average of 3.4±0.71 procedures, and the unilateral injection volume was 140-370 ml (233.9±67.7). The simultaneous implant exchange volume with fat was 160-320 ml (241.3±35.8 ml). There were 9 cases (1.2%) of palpable nodules, 3 cases of infection (0.39%), and no other severe complications. CONCLUSIONS FPFG has the advantages of requiring few operations; leading to few necrosis, oil cysts and nodules; and leading to high postoperative satisfaction.
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Affiliation(s)
- Bo Yin
- Department of Body Contouring and Fat grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Xinyu Zhang
- Department of Body Contouring and Fat grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Lei Cai
- Department of Body Contouring and Fat grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Xuefeng Han
- Department of Body Contouring and Fat grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Facheng Li
- Department of Body Contouring and Fat grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China.
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Khouri RK, Coleman SR, Yoshimura K, Rigotti G, Piccolo N, D’Amico R, Orgill DP. Commentary on: Safety and Effectiveness of Single Session Mega Volume Fat Grafting for Breast Augmentation: A Space Creating Concept and Clinical Experiences. Aesthet Surg J 2022; 42:NP589-NP591. [PMID: 35435212 DOI: 10.1093/asj/sjac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Sydney R Coleman
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kotaro Yoshimura
- Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan
| | | | | | | | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Complications and Surgical Treatment of Breast Augmentation Using Autologous Fat Transfer and Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3734. [PMID: 34414053 PMCID: PMC8367042 DOI: 10.1097/gox.0000000000003734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Background Breast augmentation with autologous fat grafting or hyaluronic acid injection requires minimal loss of healthy tissue. With an increasing trend of breast augmentation with these fillers, accompanying complications have also increased. Patients with complications often complain of induration, cyst formation, calcification, and infection, which require surgical treatment. We will discuss these complications and their surgical treatment through our experience of cases. Methods This retrospective study included 20 patients who all required surgical treatment due to breast augmentation complications such as induration, cyst formation, calcification, and infection, and who visited us between May 2007 and June 2018. The patients' ages ranged from 25 to 63, and the mean age was 39.9. The material used for breast augmentation was fat for 17 cases, and hyaluronic acid, paraffin, and silicon for one case each. The results were analyzed through plastic surgeons at our hospital. Results We performed a zigzag incision in the peri-areola margin to 17 of 18 patients for complications of autologous fat grafting and hyaluronic acid injection. The one excluded patient required an adipo-fascial flap from an inframammary fold incision. For one patient with silicon injection complication and one patient with paraffin injection complication, each required mammary gland resection. Conclusions A zigzag incision in the peri-areolar margin was useful for treating complications of breast augmentation with autologous fat grafting and hyaluronic acid injection. All cases resulted in inconspicuous fine scars, with high patient satisfaction. However, this incision was insufficient to remove injected silicon and paraffin.
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Abstract
BACKGROUND Breast augmentation with fat grafting is used as an alternative to breast implants. However, a systematic evaluation of the complication rates after fat grafting using only studies with consecutive patients has not previously been performed. In this study, the authors compiled studies reporting complication rates and radiologic changes in consecutive patients undergoing cosmetic breast augmentation with fat grafting. METHODS Studies reporting on consecutive patients undergoing breast augmentation with fat grafting were included. Complication rates, radiologic changes, Breast Imaging Reporting and Data System assessments, and the number of patients undergoing revision surgery were extracted. Mean complication rates and radiologic changes were calculated with meta-analytical methods. RESULTS Twenty-two studies with 2073 patients were included. The rates of major complications were low (hematoma, 0.5 percent; infection, 0.6 percent; and seroma, 0.1 percent). None of these patients needed revision surgery. The most frequent minor complication was palpable cysts in 2.0 percent of the patients; 67 percent of these were treated with aspiration. The radiologic changes in the patients after fat grafting were as follows: oil cysts, 6.5 percent; calcifications, 4.5 percent; and fat necrosis, 1.2 percent. The risk of being referred for additional radiologic imaging (e.g., to exclude malignant changes) was 16.4 percent, and the risk of being referred for biopsy was 3.2 percent. CONCLUSIONS The complication rates after breast augmentation with fat grafting are low and support fat grafting as an alternative to breast augmentation with implants. The rates of radiologic changes are high after fat grafting, but the changes do not seem to have any therapeutic consequences for the patients.
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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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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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Zheng D, Li M, Zhou J, Wang J, Bian W, Yoshimura K, Yu L. Effect of Salvia Miltiorrhiza Injection in Patients With Autologous Fat Grafting to the Breast: A Preliminary Comparative Study. Aesthet Surg J 2019; 39:NP243-NP252. [PMID: 30541057 DOI: 10.1093/asj/sjy318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Salvia miltiorrhiza (SM) is an herb used in Chinese medicine formulations for promoting blood circulation and minimizing vascular stasis. It has been successfully utilized in treating cardiovascular diseases, such as atherosclerosis, thromboembolism, and angina. OBJECTIVES The authors sought to study the effect of SM injections in autologous fat grafting to the breast. METHODS Fifteen women who elected to undergo breast augmentation with autologous fat grafting were included in this study. Of these, 10 were given intravenous infusions of SM for 4 weeks perioperatively, and the remaining 5 did not receive herbal infusion. The increase in breast volume after fat grafting was measured in both the groups using a three-dimensional scanner. Breast tissue specimens were harvested just before the second fat injection procedure and were analyzed by the immunofluorescence staining test. RESULTS All of the patients showed improvement in breast volume after fat grafting. The fat graft retention rate in the SM group was 60.06 ± 16.12%, whereas that in the non-SM group was 34.04 ± 11.15%. In addition, the SMG showed good breast morphology and absence of cyst formation. CONCLUSIONS SM has the potential to increase the retention rate of fat grafts in breast augmentation. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Danning Zheng
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Maoqun Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jia Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jian Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Weiwei Bian
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Kotaro Yoshimura
- Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Li Yu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Management of Fat Necrosis after Autologous Fat Transplantation for Breast Augmentation. Plast Reconstr Surg 2018; 142:665e-673e. [DOI: 10.1097/prs.0000000000004898] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ultrasound Diagnosis and Treatment of Breast Lumps after Breast Augmentation with Autologous Fat Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1603. [PMID: 29632782 PMCID: PMC5889454 DOI: 10.1097/gox.0000000000001603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/18/2017] [Indexed: 11/26/2022]
Abstract
Background: Breast augmentation with autologous fat has been performed in Japan for over 30 years. However, complications include breast lumps and oil cysts. Such breast lumps greatly reduce patient satisfaction, and are currently difficult to diagnose and treat for many cosmetic surgery clinics. This study aimed to elucidate the effectiveness of ultrasound diagnosis and treatment of patients with breast lumps after breast augmentation with autologous fat grafting. Methods: We used diagnostic and therapeutic ultrasound to examine 256 patients with breast lumps between April 2012 and April 2017. We determined the nature, size, and location of the maximal lump. Breast lumps were classified into five types: cystic, complex, solid, calcification, and unclassifiable. The method of treatment (including fine-needle aspiration, VASER liposuction, lumpectomy, and extended lumpectomy) was selected according to the lump type, and the efficacy of treatment was determined by postoperative palpation and ultrasound. Results: A total of 198 patients (198/256, 77%) requested treatment. Cystic lumps (79/256, 31%) were treated by fine-needle aspiration. VASER liposuction was used to treat complex (64/256, 25%) and solid lumps (50/256, 19%). Calcification (58/256, 23%) and unclassifiable lumps (5/256, 2%) were removed via periareolar incision. There were no serious complications. In all cases, the lumps were no longer palpable after treatment, and ultrasound showed that they had either contracted or disappeared. Conclusions: The appropriate treatment for breast lumps after breast augmentation with autologous fat grafting must be selected according to the nature of the lumps. Ultrasound is essential for diagnosing the breast lump type and determining the best treatment.
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Fat Grafting to the Breast: Clinical Applications and Outcomes for Reconstructive Surgery. Plast Reconstr Surg 2017; 140:69S-76S. [PMID: 29064924 DOI: 10.1097/prs.0000000000003945] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article is a review of fat grafting for breast reconstruction. The use of small volume fat grafting for the correction of step-off deformities, intrinsic deformities, and extrinsic deformities of the breast, and the uses of large volume fat grafting for total breast reconstruction, correction of implant complications with simultaneous implant exchange with fat, and correction of noncancer chest wall deformities is reviewed. Cancer monitoring and the risks of cancer recurrence following fat-grafting to the breast is also reviewed.
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Lindegren A, Chantereau MW, Bygdeson M, Azavedo E, Schultz I. Autologous Fat Transplantation to the Reconstructed Breast Does not Hinder Assessment of Mammography and Ultrasound: A Cohort Study. World J Surg 2016; 40:1104-11. [PMID: 26732667 DOI: 10.1007/s00268-015-3385-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Autologous fat transplantation (AFT) to the breast can correct defects and be a part of a breast reconstruction to achieve a better aesthetic result. The impact of AFT on the radiological evaluation and detection of cancer remains unclarified. The aim of this study is to investigate whether AFT induces lasting modifications. METHODS In the present study, a valuation was performed of 44 breasts from 37 patients examined with mammography and ultrasound before and after autologous fat transplantation. Breast radiologists evaluated the images using a study specific protocol. RESULTS AFT did not hinder post-operative assessment of mammograms or ultrasound. No detectable changes with serious clinical impact were found after injections of mean 177 ml (34-516) of fat in one to four sessions. The rate of oil cysts was significantly higher after AFT than pre-operatively (2.3 vs. 34.1 % p = 0.0013). Significantly more post-operative oil cysts were detected after injection of larger volumes of fat (144 vs. 243 ml, p = 0.013). No significant differences were found in the post-operative images regarding age at surgery, follow-up time, or time from previous breast surgery. CONCLUSION AFT does not impair assessment of mammograms and ultrasound in patients who have a history of breast cancer surgery or prophylactic mastectomy.
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Affiliation(s)
- Anna Lindegren
- Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 11883, Stockholm, Sweden. .,Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.
| | - Marie Wickman Chantereau
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.,Department of Reconstructive and Plastic Surgery, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
| | - Malin Bygdeson
- Department of Radiology, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
| | - Edward Azavedo
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
| | - Inkeri Schultz
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.,Department of Reconstructive and Plastic Surgery, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
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Autologous Fat Grafting After Breast Reconstruction in Postmastectomy Patients: Complications, Biopsy Rates, and Locoregional Cancer Recurrence Rates. Ann Plast Surg 2016; 76:270-5. [PMID: 26101979 DOI: 10.1097/sap.0000000000000561] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Autologous fat grafting is widely used for refinements in postmastectomy breast reconstruction. However, there are few studies evaluating outcomes in this patient population. The purpose of this study was to assess outcomes of autologous fat grafting after breast reconstruction in postmastectomy patients. METHODS We retrospectively reviewed the records of consecutive postmastectomy patients who underwent autologous fat grafting after breast reconstruction at a university center over a 5-year period. Patients with at least 6 months of follow-up were included. Medical records were reviewed for demographics, operative details, complications, incidence of palpable masses, and/or suspicious breast imaging findings requiring biopsy, and locoregional cancer recurrence. Descriptive statistics were generated. RESULTS Between January 2008 and July 2013, 108 women and a total of 167 breast reconstructions underwent autologous fat grafting for revision of postmastectomy breast reconstruction. Their ages ranged from 22 to 71 years (mean, 48 years). Fat grafts were harvested, processed, and injected using the Coleman technique. The mean number of fat grafting procedures was 1.3 (range, 1-4) per breast. Follow-up ranged from 6 to 57 months (mean, 20.2 months). Fifty-three (31.7%) breasts underwent imaging after autologous fat grafting. Suspicious imaging findings requiring biopsy were discovered in 4 (2.4%) breasts, and clinically palpable lesions combined with suspicious imaging findings requiring biopsy were present in another 4 (2.4%) breasts. All 8 biopsies showed fat necrosis, scar, or oil cysts without evidence of malignancy. One (0.6%) local complication (a wound infection at the recipient site requiring oral antibiotics) after autologous fat grafting was reported. During the limited follow-up period, there were no locoregional cancer recurrences. CONCLUSIONS Autologous fat grafting in conjunction with breast reconstruction resulted in a biopsy rate of 4.8%, and no cases of locoregional cancer recurrence were observed. Based on these preliminary findings, autologous fat grafting appears to be a relatively safe procedure for refinement of the reconstructed breast in postmastectomy patients.
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21
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De Decker M, De Schrijver L, Thiessen F, Tondu T, Van Goethem M, Tjalma WA. Breast cancer and fat grafting: efficacy, safety and complications-a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 207:100-108. [PMID: 27835828 DOI: 10.1016/j.ejogrb.2016.10.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 10/07/2016] [Accepted: 10/21/2016] [Indexed: 01/19/2023]
Abstract
Autologous fat grafting (AFG) or lipofilling is nowadays a popular technique for breast reconstruction after breast cancer surgery. There is debate regarding the oncological safety and risks of this procedure in breast cancer patients. A systematic review of the literature published between January first 1995 and October first 2016 was conducted regarding the efficacy, safety and complications of this technique in breast cancer patients after their cancer treatment. The databases PubMed, Science Direct and Thomson Reuters Web of Science were used to search for qualified articles. Inclusion criteria were women with a personal history of breast cancer and at least one lipofilling procedure. Only studies containing a minimum of 20 patients were included in this systematic review. The search yielded a total of 23 suitable articles: 18 case series, 4 retrospective cohort studies and one prospective cohort study. The systematic review encompassed a total of 2419 patients. Medical imaging was used in the majority of the studies to assess the follow-up. Mammography was the most popular technique (65.2%), followed by ultrasound (47.8%) and MRI (30.4%). The prevalence of complications was the following: fat necrosis in 5.31%, benign lesions, like cysts or calcifications in 8.78%, infections in 0.96% and local cancer recurrence in 1.69%. AFG or lipofilling appears to be an oncological safe technique with a low morbidity in women with a history of breast cancer. In order to have a better understanding and evidence of the oncological safety a randomised controlled trial is urgently needed. We further recommend that all AFG be registered in the cancer register.
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Affiliation(s)
- M De Decker
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - L De Schrijver
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - F Thiessen
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Plastic Surgery Unit, Antwerp University Hospital, Antwerpen, Belgium
| | - T Tondu
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Plastic Surgery Unit, Antwerp University Hospital, Antwerpen, Belgium
| | - M Van Goethem
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Department of Radiology, Antwerp University Hospital, Antwerpen, Belgium
| | - W A Tjalma
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Unit of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium.
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22
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Groen JW, Negenborn VL, Twisk JWR, Ket JCF, Mullender MG, Smit JM. Autologous Fat Grafting in Cosmetic Breast Augmentation: A Systematic Review on Radiological Safety, Complications, Volume Retention, and Patient/Surgeon Satisfaction. Aesthet Surg J 2016; 36:993-1007. [PMID: 27329661 DOI: 10.1093/asj/sjw105] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Autologous fat grafting (AFG) is increasingly used in cosmetic surgery. However, its efficacy and safety are still ambiguous. Both a comprehensive overview and recapitulation of the relevant literature provide current evidence on the efficacy and outcomes of AFG in cosmetic breast surgery. OBJECTIVES This review provides an up-to-date overview of the literature on AFG in cosmetic breast augmentation. METHODS A systematic review of the literature on AFG used for cosmetic breast augmentation was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This study included selected studies that were published between January 1996 and February 2016 and reported on 10 patients or more who had a minimal mean follow-up period of 1 year. RESULTS In this study, 22 articles that reported on 3565 patients with follow-up periods ranging from 12 to 136 months were included. A complication rate of 17.2% (95% CI 15.9-18.5) was seen. Indurations were the most frequent complication (33.3%, 95% CI 20.4-46.3), followed by persistent pain (25%, 95% CI 0.5-49.5), and hematoma (16.4%, 95% CI 14.5-18.4). Mammograms revealed micro-calcifications (9.0%, 95% CI 6.4-11.5) and macro-calcifications (7.0%, 95% CI 3.8-10.2). The mean volume retention was 62.4% (range, 44.7-82.6%), with a satisfaction rate of 92% in patients and 89% in surgeons. CONCLUSIONS AFG is a promising method in achieving autologous cosmetic breast augmentation with satisfactory volume retention and satisfaction rates in eight and six studies, respectively. Complications and radiological findings are comparable to those after implant augmentation. Future studies should focus on cancer occurrence and detection to further substantiate AFG safety. In addition, grafting methods and the use of auxiliary procedures to identify factors leading to better outcomes in terms of volume retention should be investigated. Finally, objective questionnaires are needed to represent patient satisfaction. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Jan-Willem Groen
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Vera L Negenborn
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C F Ket
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Maerten Smit
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
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Kristensen RN, Gunnarsson GL, Børsen-Koch M, Reddy A, Ømark H, Sørensen JA, Thomsen JB. Fast and simple fat grafting of the breast. Gland Surg 2015; 4:572-6. [PMID: 26645013 DOI: 10.3978/j.issn.2227-684x.2015.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Fat grafting (FG) is being used at an escalating rate for correction of shape and volume of all types of breast surgery in order to optimize the aesthetic result in spite of an ongoing debate of the oncologic safety. In this paper we demonstrate our simple and fast sedimentation based FG technique in the attached video as visualized surgery. We have used this simple approach for 348 procedures in 176 women to optimize and correct the aesthetic result following all types of breast surgery. We prefer this simple technique as no technique has been shown to be superior to other more costly techniques and furthermore there are still questions about the oncologic safety in using adipose derived stem cells (ADSC). Simple fat harvesting using low vacuum and preparation by sedimentation is a fast and effective method to perform FG successfully for correction of shape and volume deficits of the breast following both ablative surgery as well as benign conditions with a high margin of safety.
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Affiliation(s)
- Rasmus Nygård Kristensen
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Gudjon L Gunnarsson
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Mikkel Børsen-Koch
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Ashwin Reddy
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Henrik Ømark
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Jens Ahm Sørensen
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Jørn Bo Thomsen
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
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Voglimacci M, Garrido I, Mojallal A, Vaysse C, Bertheuil N, Michot A, Chavoin JP, Grolleau JL, Chaput B. Autologous fat grafting for cosmetic breast augmentation: a systematic review. Aesthet Surg J 2015; 35:378-93. [PMID: 25908697 DOI: 10.1093/asj/sjv030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Breast augmentation is one of the most popular aesthetic surgical procedures. The only potential alternative is autologous fat grafting (AFG), which is not new in principle. This procedure has been used on native breasts since 2009, following the recommendations of some learned societies. OBJECTIVES We performed a systematic review to determine the current worldwide status of fat grafting for aesthetic breast augmentation. METHODS A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria was conducted using the PubMed, EmBASE, and Cochrane library databases. This protocol was registered at the National Institute for Health Research, Prospective Register of Systematic Reviews. RESULTS A total of 42 articles published between 1987 and July 2014 were included. Most of the studies had a low level of evidence, with only one level 2 study, published by Spear (2014), a prospective cohort study which included 10 patients. The publications were from North America, Europe, and Asia. The indications were aesthetic augmentation (92.4%) and congenital malformation (7.6%). Two cases of cancer were reported among the 2023 patients included (0.09%), with a mean follow-up of 22 months, although the follow-up was insufficient for medium- and long-term cancer diagnoses. CONCLUSIONS AFG seems to be a major tool in this field, but we must remain cautious about its systematization for this indication. Preoperative patient selection is essential but underreported. AFG appears particularly relevant in breast malformations. We believe that this method should be practiced within the scope of a national or international registry with proper follow-up of patients.
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Affiliation(s)
- Marie Voglimacci
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Ignacio Garrido
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Ali Mojallal
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Charlotte Vaysse
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Nicolas Bertheuil
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Audrey Michot
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Jean Pierre Chavoin
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Jean Louis Grolleau
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
| | - Benoit Chaput
- Drs Voglimacci and Chaput are Staff Surgeons and Drs Garrido, Grolleau, and Chavoin are Professors in the Department of Plastic, Reconstructive, Burns, and Aesthetic Surgery at the University of Toulouse Rangueil, France. Dr Mojallal is a Professor in the Department of Plastic, Aesthetic, and Reconstructive Surgery at Edouard Herriot Hospital, University of Lyon, France. Dr Vaysse is a Staff Surgeon in the Department of Surgery and Gynecology and a member of the Faculty of Medicine at the University of Toulouse Rangueil, France. Dr Bertheuil is a Staff Surgeon in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Hospital Sud, University of Rennes 1, France. Dr Michot is a Staff Surgeon in the Department of Surgical Oncology at the Institut Bergonié and a member of the Faculty of Medicine at the University of Bordeaux Segalen, France
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Fat grafting: a citation analysis of the seminal articles. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e295. [PMID: 25674376 PMCID: PMC4323399 DOI: 10.1097/gox.0000000000000269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023]
Abstract
Background: There has been substantial rise in the volume of published works on fat transfer in the medical literature in the past 25 years, and this is indicative of its growing popularity. However, many unanswered questions remain, and there is no consensus as to the optimum technique. Consequently, the scientific and clinical research on fat grafting continues to increase rapidly. The purpose of our study was to perform a bibliometric analysis of the most-cited articles in fat transfer. Methods: Through the Web of Science, all articles relating to fat grafting were identified in the plastic and reconstructive literature. The 100 most-cited articles were identified and analyzed individually. Results: Total citations ranged from 35 to 363 and the most-cited paper by Sidney Coleman was published in Plastic and Reconstructive Surgery. The United States produced 46% of the most-cited papers, and the University of California was the most prolific institution. Twenty-one articles focused on lipofilling to the face while 14 articles looked at fat grafting to the breast. Conclusions: The scientific relevance of a published work is reflected in the number of citations from peers that it receives. Therefore, the 100 most-cited papers in fat grafting have been the most influential articles on this field, and they are likely to be the ones that are remembered most.
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Kim DH, Kim KS. A Case of Liponecrotic Pseudocyst after Breast Augmentation by Autologous Fat Injection. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2015. [DOI: 10.14730/aaps.2015.21.3.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dae Hyun Kim
- Department of Plastic and Reconstructive Surgery, Myong-Ji Hospital, Goyang, Korea
| | - Kyung Sik Kim
- Department of Plastic and Reconstructive Surgery, Myong-Ji Hospital, Goyang, Korea
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Park SY, Han BK, Cho EY, Bang SI. Chest Wall Lipogranuloma after Hydrogel Implant Rupture: Case Report. ACTA ACUST UNITED AC 2015. [DOI: 10.13104/imri.2015.19.3.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- So Yoon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sa-Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Breast total male breast reconstruction with fat grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e257. [PMID: 25506540 PMCID: PMC4255900 DOI: 10.1097/gox.0000000000000221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/02/2014] [Indexed: 11/26/2022]
Abstract
Summary: Cancer of a male breast represents less than 1% of all breast cancer. As with to female patients, mastectomy in men creates a substantial emotional burden. Breast reconstruction may improve the patient’s psychological well-being, compliance with adjuvant treatments, and overall outcome. However, due to the unique anatomy of the male breast, standard reconstructive strategies using anatomic or prosthetic modalities are not entirely applicable. We describe a case of a 68-year-old male patient who underwent successful unilateral breast reconstruction solely with fat grafting technique.
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Naderi N, Wilde C, Haque T, Francis W, Seifalian AM, Thornton CA, Xia Z, Whitaker IS. Adipogenic differentiation of adipose-derived stem cells in 3-dimensional spheroid cultures (microtissue): Implications for the reconstructive surgeon. J Plast Reconstr Aesthet Surg 2014; 67:1726-34. [DOI: 10.1016/j.bjps.2014.08.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/16/2014] [Accepted: 08/07/2014] [Indexed: 01/22/2023]
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Arleo EK, Saleh M, Schwartz MH, Eisen CS. Cosmetic fat augmentation following breast reconstruction: sonographic appearance with cytopathologic correlation. Clin Imaging 2014; 38:872-6. [PMID: 25128090 DOI: 10.1016/j.clinimag.2014.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/02/2014] [Accepted: 07/10/2014] [Indexed: 12/11/2022]
Abstract
This series presents the history and imaging of patients who had cosmetic fat augmentation following mastectomy and reconstruction. The cases provide the useful reminder that a complete surgical history is essential when assessing the imaging of a post-operative breast patient and that speaking directly with patients can be a critical step in putting together a complete clinical picture and adding value to their care.
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Affiliation(s)
- Elizabeth Kagan Arleo
- New York-Presbyterian Hospital, Weill Cornell Medical Center, 425 East 61st Street, New York, NY 10065.
| | - Marwa Saleh
- New York-Presbyterian Hospital, Weill Cornell Medical Center, 425 East 61st Street, New York, NY 10065
| | - Mark H Schwartz
- New York-Presbyterian Hospital, Weill Cornell Medical Center, 425 East 61st Street, New York, NY 10065
| | - Carolyn Sharyn Eisen
- New York-Presbyterian Hospital, Weill Cornell Medical Center, 425 East 61st Street, New York, NY 10065
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Chronic Inflammation and Progressive Calcification as a Result of Fat Necrosis. Plast Reconstr Surg 2014; 133:1064-1072. [DOI: 10.1097/prs.0000000000000097] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Largo RD, Tchang LA, Mele V, Scherberich A, Harder Y, Wettstein R, Schaefer DJ. Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: A systematic review. J Plast Reconstr Aesthet Surg 2014; 67:437-48. [DOI: 10.1016/j.bjps.2013.11.011] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 11/07/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
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Jet-assisted fat transfer to the female breast: preliminary experiences. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0934-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hoppe DL, Ueberreiter K, Surlemont Y, Peltoniemi H, Stabile M, Kauhanen S. Breast reconstruction de novo by water-jet assisted autologous fat grafting--a retrospective study. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2013; 11:Doc17. [PMID: 24403878 PMCID: PMC3884560 DOI: 10.3205/000185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 11/15/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone. METHODS A retrospective European multicenter trial included 135 procedures on 28 (35 breasts) postmastectomy patients (mean 52.4 years). All women were treated with the water-jet assisted fat grafting method (BEAULI™) combined with additional procedures (NAC reconstruction, contralateral mastoplasty) and evaluated with at least 6 months follow-up (mean 2.6 years). Sonography or mammography, clinical examination, patient questionnaire (10-point Likert scale) and digital photographs were carried out. RESULTS On average the patients received 4 to 6 procedures each with a single volume of 159 ml (±61 ml) over 21 months (range 9 months to 2.5 years). In total 1,020 ml (±515 ml) fat were grafted till a complete breast reconstruction was achieved. Irradiated patients needed a significantly higher volume than non-irradiated (p<0.041). Main treatment complications were liponecrosis (2.59%), infection (0.74%) and granuloma (0.74%). Patient satisfaction was overall high to very high (96%) and confirmed the good aesthetic results (68%) and the natural softness, contour and shape of the reconstructed breast. CONCLUSIONS A complete breast reconstruction with large volume fat grafting is alternatively possible to standard techniques in selected cases. It takes at least 4 to 6 lipotransfers in the course of 2 years. Patients with prior radiotherapy may require even up to 8 sessions over nearly 3 years of treatment.
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Affiliation(s)
- Delia Letizia Hoppe
- BG Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen, Germany
| | | | - Yves Surlemont
- Clinique Saint Antoine, Rouen University Hospital, Paediatric and Dermatologic Plastic Surgery, Bois Guillaume, France
| | | | | | - Susanna Kauhanen
- Helsinki University Hospital, Department of Plastic and Reconstructive Surgery, Helsinki, Finland
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Bonomi R, Betal D, Rapisarda I, Kalra L, Sajid M, Johri A. Role of lipomodelling in improving aesthetic outcomes in patients undergoing immediate and delayed reconstructive breast surgery. Eur J Surg Oncol 2013; 39:1039-45. [DOI: 10.1016/j.ejso.2013.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 06/21/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022] Open
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Pozner JN, White JB, Newman MI. Use of porcine acellular dermal matrix in revisionary cosmetic breast augmentation. Aesthet Surg J 2013; 33:681-90. [PMID: 23813397 DOI: 10.1177/1090820x13491279] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Aesthetic breast augmentation can be fraught with postoperative complications, particularly capsular contracture (CC), skin surface irregularities, and implant or inframammary fold malposition. Similar complications have been addressed successfully in reconstructive breast surgery with acellular dermal matrix (ADM) products. OBJECTIVE The authors present their initial experience with porcine ADM (PADM) in aesthetic breast augmentation. METHODS Retrospective chart review was performed for 93 consecutive patients (179 breasts) who underwent revisionary cosmetic breast augmentation with or without mastopexy between May 2009 and September 2012. Porcine ADM (Strattice; Lifecell Corp, Branchburg, New Jersey) was placed bilaterally in 74 patients and unilaterally in 19 patients. All patients were operated upon by 1 surgeon (J.N.P.). Product use description and complications were recorded, including infection, extrusion, CC, and implant malposition. RESULTS Average follow-up was 12 months (range, 1-39 months). There were 2 major complications (1.6% of breasts): an infection in 1 breast that required implant explantation approximately 2 weeks postoperatively and an extrusion that required PADM removal. Two additional patients had high-riding implants resulting from folded PADM that required revision; both cases were corrected by excising the folded PADM segment. Seven other patients required office procedures to correct minor imperfections. Two CC recurrences were suspected (1 patient) in the 76 breasts that underwent capsulectomy and PADM placement. CONCLUSIONS Porcine ADM demonstrated great utility as an adjunct in revisionary cosmetic breast surgery. The product helped to provide good aesthetic outcomes with low complication rates. Prospective, randomized trials may prove helpful in defining the role of PADM further in these challenging cases.
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Affiliation(s)
- Jason N Pozner
- Department of Plastic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
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Autologous fat transplantation: volumetric tools for estimation of volume survival. A systematic review. Aesthetic Plast Surg 2013; 37:380-7. [PMID: 23354764 DOI: 10.1007/s00266-012-0046-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Autologous fat transplantation has gained great recognition in aesthetic and reconstructive surgery. Two main aspects are of predominant importance for progress control after autologous fat transplantation to the breast: quantitative information about the rate of fat survival in terms of effective volume persistence and qualitative information about the breast tissue to exclude potential complications of autologous fat transplantation. There are several tools available for use in evaluating the rate of volume survival. They are extensively compared in this review. The anthropometric method, thermoplastic casts, and Archimedes' principle of water displacement are not up to date anymore because of major drawbacks, first and foremost being reduced reproducibility and exactness. They have been replaced by more exact and reproducible tools such as MRI volumetry or 3D body surface scans. For qualitative and quantitative progress control, MRI volumetry offers all the necessary information: evaluation of fat survival and diagnostically valuable imaging to exclude possible complications of autologous fat transplantation. For frequent follow-up, e.g., monthly volume analysis, repeated MRI exams would not be good for the patient and are not cost effective. In these cases, 3D surface imaging is a good tool and especially helpful in a private practice setting where fast data acquisition is needed. This tool also offers the possibility of simulating the results of autologous fat transplantation. 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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Chiu CH. A “Solid Injection Method” to Reduce Postoperative Complications in Autologous Fat Grafting for Breast Augmentation. ACTA ACUST UNITED AC 2013. [DOI: 10.5992/ajcs-d-12-00050.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Radiological findings in mammary autologous fat injections: A multi-technique evaluation. Clin Radiol 2013; 68:27-33. [DOI: 10.1016/j.crad.2012.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/16/2012] [Accepted: 05/01/2012] [Indexed: 11/18/2022]
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Abstract
BACKGROUND The contour of the arm is determined by muscular shape and volume. Liposuction in this area is challenging due to the difficulties of achieving symmetry and the high risk of contour irregularities due to fat structures in the region. OBJECTIVE The authors describe a new technique to achieve muscular definition in the arm. METHODS From January 2005 to December 2011, a total of 651 arm-sculpting procedures were performed in consecutive patients. Patients with body mass index (BMI) >30 kg/m(2) and/or severe skin laxity were excluded. Fat grafting was performed in the deltoid area in selected cases. The areas of fat extraction and grafting were specific to gender: in men, an athletic, muscular look was preferred, whereas in women, a slimmer and less-defined shape was desired. RESULTS Of the 651 patients, 158 were men (24.3%) and 493 were women (75.7%). Most patients (98.3%) were satisfied with the results in arm dynamic definition. All patients underwent other body contouring procedures at the time of arm enhancement. Complications (n = 21) included 1 soft tissue abscess in the posterior arm, 2 unilateral hematomas, and 3 unilateral seromas that required puncture, along with 15 cases of minor asymmetry. Transitory hardening of the skin of the posterior arm was frequent (n = 104) due to superficial fat extraction, but all cases resolved within 6 months. CONCLUSION The authors were able to achieve natural results with this new procedure in arm contouring. The technique is safe and effective with reproducible results when performed through multilayer fragmentation and liposuction with an anatomical extraction. Fat grafting can be performed for contouring with no additional complications.
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Dynamic-definition male pectoral reshaping and enhancement in slim, athletic, obese, and gynecomastic patients through selective fat removal and grafting. Aesthetic Plast Surg 2012; 36:1066-77. [PMID: 22833139 DOI: 10.1007/s00266-012-9940-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND One of the most appealing characteristics of an athletic male body is a well-defined pectoral area. For decades, implants have been the gold standard method for the treatment of this area, but it is not suitable for every case. The goal was to design a mixed technique combining autologous fat extraction and grafting in an anatomically guided fashion to produce a highly athletic contour in the male pectoral. METHODS The patient criteria included a body mass index (BMI) lower than 30 kg/m(2), adequate skin tone, and general good health. A three-phase procedure was performed, beginning with infiltration of tumescent solution and followed by fragmentation of extra fat in an anatomic fashion using internal third-generation ultrasound; extraction that blends deep, intermediate, and superficial fat removal; and multilayer fat grafting in the pectoral area. In the presence of gynecomastia, a selective pull-through technique was used in an anatomic manner. RESULTS In a series of 154 consecutive male patients, the minor complications (n = 15) included asymmetries (n = 10) and residual gynecomastia (n = 5). The major complications (n = 3) included unilateral hematoma (n = 2), and abscess that required sonographic-guided removal (n = 1). An appealing muscular contour was produced in most patients, and the satisfaction rate was very high. CONCLUSION Implants are no longer the only option for defining and augmenting the male chest. Combining fat grafting in a multilayer fashion with precise anatomic fat and gland removal achieved a contoured and athletic male pectoral in a safe and reproducible manner. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article.
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Schultz I, Lindegren A, Wickman M. Improved shape and consistency after lipofilling of the breast: patients' evaluation of the outcome. J Plast Surg Hand Surg 2012; 46:85-90. [PMID: 22471255 DOI: 10.3109/2000656x.2011.653256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Autologous transplantation of fat, or lipofilling, of the breast can correct deformities after reconstruction and after conservation surgery for cancer. We have made a retrospective evaluation of morbidity and patients' experiences of the method. Forty-four patients have had lipofilling once, twice, or three times (mean transplanted volume 40 ml, range 6-200 ml). One minor complication, a local infection, was treated with antibiotics given orally, and recorded at follow up. A questionnaire was sent to all 44 patients and answered by 43. Twenty-nine of the 43 patients reported improvement of irregularities after lipofilling, 26 reported that the shape of the breast had improved, 26 that the consistency had improved, and 20 that the size had increased postoperatively. Five of the patients reported some adverse effects; one case of liponecrosis that did not need any treatment was found one year postoperatively. No problems were reported at the donor site at follow-up.
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Affiliation(s)
- Inkeri Schultz
- Section of Reconstructive Plastic Surgery, Institution of Molecular Medicine and Surgery, University Hospital Solna, Karolinska Institute, Stockholm, Sweden.
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Claro F, Figueiredo JCA, Zampar AG, Pinto-Neto AM. Applicability and safety of autologous fat for reconstruction of the breast. Br J Surg 2012; 99:768-80. [PMID: 22488516 DOI: 10.1002/bjs.8722] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Autologous fat grafting to the breast for cosmetic and reconstructive purposes is still controversial with respect to its safety and efficacy. The objective of this study was to conduct a systematic review of the clinical applicability and safety of the technique. METHODS An online search of the Cochrane Library, MEDLINE, Embase and SciELO was conducted from July 1986 to June 2011. Studies included in the review were original articles of autologous liposuctioned fat grafting to the female breast, with description of clinical complications and/or radiographic changes and/or local breast cancer recurrence. RESULTS This review included 60 articles with 4601 patients. Thirty studies used fat grafting for augmentation and 41 for reconstructive procedures. The incidence of clinical complications, identified in 21 studies, was 3·9 per cent (117 of 3015); the majority were induration and/or palpable nodularity. Radiographic abnormalities occurred in 332 (13·0 per cent) of 2560 women (17 studies); more than half were consistent with cysts. Local recurrence of breast cancer (14 of 616, 2·3 per cent) was evaluated in three studies, of which only one was prospective. CONCLUSION There is broad clinical applicability of autologous fat grafting for breast reconstruction. Complications were few and there was no evidence of interference with follow-up after treatment for breast cancer. Oncological safety remains unclear.
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Affiliation(s)
- F Claro
- Department of Gynaecology and Obstetrics, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil.
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Kim H, Yang EJ, Bang SI. Bilateral liponecrotic pseudocysts after breast augmentation by fat injection: a case report. Aesthetic Plast Surg 2012; 36:359-62. [PMID: 21805233 DOI: 10.1007/s00266-011-9790-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/24/2011] [Indexed: 10/17/2022]
Abstract
Breast augmentation with autologous fat injection is becoming increasingly popular. This article aims to describe bilateral liponecrotic pseudocysts after injection of fat into the breast. A 42-year-old woman presented with palpable indurations and pain with pressure. She also showed abnormalities on her breast cancer screening. The woman underwent mammography, magnetic resonance imaging, and pathologic confirmation to evaluate the breast abnormalities. These radiologic examinations were consistent with liponecrotic pseudocysts on both sides. Bilateral lumpectomies were performed through an inframammary approach. Histologic examination of the specimens showed fat necrosis and dystrophic calcification. Autologous fat grafting to the breast is not a simple procedure and should be performed by well-trained and skilled plastic surgeons. During the surgery, caution should be exercised.
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Rosing JH, Wong G, Wong MS, Sahar D, Stevenson TR, Pu LLQ. Autologous fat grafting for primary breast augmentation: a systematic review. Aesthetic Plast Surg 2011; 35:882-90. [PMID: 21455825 DOI: 10.1007/s00266-011-9691-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 02/17/2011] [Indexed: 11/28/2022]
Abstract
As the technique of autologous fat grafting is being refined and perfected, its clinical applications are expanding. The use of autologous fat grafting for primary breast augmentation is controversial due to a lack of clarity regarding its safety and efficacy. Most notably, concerns about interference with the detection of breast cancer have been raised, but these have not been clearly addressed in the literature. To help surgeons gain further insight, the authors conducted a systematic review of the literature, carefully comparing technique, clinical outcome, radiologic impact, and complications in all available data on this subject. Although an optimal method of autologous fat grafting for primary breast augmentation is yet to be standardized, further strong evidence-based studies are necessary to confirm the findings of this approach.
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Affiliation(s)
- James H Rosing
- Division of Plastic Surgery, University of California at Davis, 2221 Stockton Boulevard, Suite 2123, Sacramento, CA 95817, USA.
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Gimble JM, Bunnell BA, Chiu ES, Guilak F. Concise review: Adipose-derived stromal vascular fraction cells and stem cells: let's not get lost in translation. Stem Cells 2011; 29:749-54. [PMID: 21433220 DOI: 10.1002/stem.629] [Citation(s) in RCA: 418] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Subcutaneous fat has emerged as an alternative tissue source for stromal/stem cells in regenerative medicine. Over the past decade, international research efforts have established a wealth of basic science and preclinical evidence regarding the differentiation potential and regenerative properties of both freshly processed, heterogeneous stromal vascular fraction cells and culture expanded, relatively homogeneous adipose-derived stromal/stem cells. The stage has been set for clinicians to translate adipose-derived cells from the bench to the bedside; however, this process will involve "development" steps that fall outside of traditional "hypothesis-driven, mechanism-based" paradigm. This concise review examines the next stages of the development process for therapeutic applications of adipose-derived cells and highlights the current state of the art regarding clinical trials. It is recommended that the experiments addressing these issues be reported comprehensively in the peer-review literature. This transparency will accelerate the standardization and reproducibility of adipose-derived cell therapies with respect to their efficacy and safety.
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Affiliation(s)
- Jeffrey M Gimble
- Stem Cell Biology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808, USA.
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Abstract
Revisionary breast surgeries are challenging, and advanced techniques must often be utilized in the correction of the underlying anatomical deformities. In this Featured Operative Technique, the authors describe their method, which includes a combination of revisionary surgery techniques with site change and acellular dermal matrices. This use of acellular dermal matrices has four indications based on the underlying clinical presentation: (1) as a lower pole implant interface (usually for revision mastopexy), (2) as a capsular contracture treatment (technically similar to lower pole interface), (3) as a tissue thickener (superomedial or inferolateral implant interface), or (4) as an implant stabilizer (malposition correction).
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Affiliation(s)
- G Patrick Maxwell
- Department of Plastic Surgery, Loma Linda University Medical Center, California, USA
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Lee KS, Seo SJ, Park MC, Park DH, Kim CS, Yoo YM, Lee IJ. Sepsis with multiple abscesses after massive autologous fat grafting for augmentation mammoplasty: a case report. Aesthetic Plast Surg 2011; 35:641-5. [PMID: 21057949 DOI: 10.1007/s00266-010-9605-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/14/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Autologous fat grafting to the breast for breast reconstruction and cosmetic breast augmentation has gained much attention recently. However, its efficacy and the severities of its associated complications are of concern. The authors experienced one case of multiple breast abscesses after augmentation mammoplasty by autologous fat grafting. METHODS A 42-year-old woman presented to the authors' emergency department reporting tenderness, swelling, and a sensation of heat in both breasts. The patient had undergone augmentation mammoplasty by autologous fat grafting 7 days previously. Abscess formation was suspected based on the patient's history, physical examination, laboratory findings, and image study. RESULTS Incision and drainage were performed immediately with the patient under general anesthesia, and 500 ml of a foul, brown, turbid, purulent fluid containing necrotic fat debris was drained from each breast. Empiric antibiotics were started on the first hospital day, and betadine and saline-irrigation were administered daily for 2 weeks. Incisions were closed on hospital day 19 when laboratory data and local infection signs had improved. At the patient's 9-month follow-up assessment, breast contours were found to be well preserved, and scarring was minimal. CONCLUSION Immediate complications such as edema, hematoma, and infection require serious consideration after autologous fat grafting in the breast. In particular, infection probably is the most serious complication because the volume of the fat injected is large and can induce systemic infections such as sepsis and distort the contours of the breast. To avoid such infections, systemic and multicenter studies are required to determine how fat grafting should be performed to minimize the risks of fat necrosis and infection.
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Affiliation(s)
- Keu Sung Lee
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Woncheon-Dong, Yeongtong-Gu, Suwon, Gyeongi-Do 443-721, Korea
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