Breast Augmentation by Autologous Fat Injection Grafting

Pathological characteristics of breast nodules after large-volume fat grafting for breast augmentation

BACKGROUND

The complications of large-volume fat grafting (LVFG) for breast augmentation remain unpredictable and include palpable breast nodules, oil cysts, and calcifications.

AIMS

This study was aimed to provide an optimal treatment option for breast nodules after LVFG and evaluate their pathological characteristics.

PATIENTS/METHODS

We effectively performed complete resection of breast nodules in 29 patients after LVFG using a minimal skin incision with the vacuum-assisted breast biopsy (VABB) system under ultrasound guidance. And we further carried on histologic examination of excised nodules and evaluated their pathological characteristics.

RESULTS

The breast nodules were excised thoroughly with cosmetic effect satisfactorily. Interestingly, subsequent histologic examination showed that type I and VI collagens were strongly expressed in the fibrotic area and type IV collagen were positively expressed around the blood vessel. Furthermore, we found that the type VI collagen+ area appeared around mac2+ macrophages and α-SMA+ myofibroblasts.

CONCLUSIONS

The VABB system may be the optimal treatment option for breast nodules after LVFG. And type VI collagens may serve as a biomarker of grafted adipose tissue fibrosis. The relationship between macrophages, fibroblasts, and collagen formation may be therapeutic targets for regulating fibrosis.

Facial fat necrosis after autologous fat transfer possibly associated with SARS-CoV-2 vaccine

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.

The treatment of symptomatic fat necrosis: A review and introduction of a new treatment algorithm

OBJECTIVE

Fat necrosis (FN) is a well-known complication in plastic surgery. Excision of symptomatic FN has been the gold standard, but it often results in contour irregularities that require subsequent treatment. Different alternative surgical and nonsurgical management strategies have been described; however, there are currently no guidelines. This literature review aims to provide an overview of available treatment options and current management standards to support clinical decision making.

METHOD

A literature search in the databases PubMed, Embase (via Ovid), and Web Of Science was carried out to identify eligible articles. The search strategy included combinations of the following terms: "Fat necrosis "AND (treatment OR management OR therapy). Six articles discussing or reporting management strategies of FN in a plastic surgery context were included.

RESULTS

A variety of techniques were used to manage symptomatic FN. Asymptomatic or small lesions can be treated conservatively. Oil cyst and moderately sized areas of symptomatic FN can effectively be treated by aspiration, ultrasound-assisted liposuction, or needle aeration. Calcified and large areas of FN require excision and debridement of necrotic fat tissue CONCLUSION: At present, there is no consensus on the management of symptomatic FN. The authors propose a new classification system to aid the guidance of management of symptomatic FN.

The Palpable Nodule After Autologous Fat Grafting: Distinguishing Benign Versus Malignant Lesions in a Breast Reconstruction Cohort

BACKGROUND

Nodule formation after autologous fat grafting (AFG) to the breast is the most common complication. In the reconstructive population, this generates significant patient anxiety and presents a diagnostic challenge. We characterized palpable nodule occurrence after AFG in breast reconstruction and compared benign versus malignant nodule characteristics.

METHODS

Chart review of the senior author's experience with breast fat grafting was performed. Data extracted included demographics, intra-operative details, nodule data, radiographic characteristics and biopsy results. Logistic regression identified risk factors for nodule formation. Unpaired t-tests and Fisher's exact tests compared characteristics of benign versus malignant nodules.

RESULTS

In total, 7 75 breasts were identified that underwent 1,158 fat grafting procedures, of which 67 (8.6%) developed palpable nodules. Sonographic characterization of nodules included presumed fat necrosis (38.2%), benign lesion (27.6%), presumed oil cysts (17.1%), indeterminate (8.9%) and concerning for malignancy (8.1%). Lesions concerning for malignancy were more often irregular (10.0% versus 0-2.9% of benign nodules) and more often larger than 0.8 cm in greatest dimension (80% versus 42.9%-61.8% of benign nodules). Six patients developed a palpable local recurrence. Malignant nodules tended to be larger (1.45 cm versus 0.70 cm, p=0.03), were more often vascular (50% versus 3.8%, p=0.03) and tended to occur later (17.5 months versus 10.0 months, p=0.60). Benign nodules occurred in the setting of larger fat graft volumes (64.2 cc versus 40.0 cc, p=0.008).

CONCLUSION

This study provides the first comparison of radiographic and clinical characteristics between benign and malignant palpable nodules post-AFG in breast reconstruction.

UK Guidelines for Lipomodelling of the Breast on behalf of Plastic, Reconstructive and Aesthetic Surgery and Association of Breast Surgery Expert Advisory Group

Lipomodelling has become increasingly popular for reconstructive, aesthetic and therapeutic indications. The guidelines summarise available evidence for indications, training, technique, audit and outcomes in lipomodelling and also highlight areas for further research.

[Diagnosis and management of fat necrosis after autologous fat transplantation of breast]

Objective

To review the diagnosis and management of fat necrosis after autologous fat transplantation of breast.

Methods

Based on the latest related literature, the pathology, clinical and radiographic examinations, influence factors, as well as the management of fat necrosis after autologous fat transplantation for breast augmentation and reconstruction were summarized.

Results

Fat necrosis after breast autologous fat transplantation is histologically manifested as hyaline degeneration, fibrosis, and calcification. The diagnosis of fat necrosis includes clinical examination, imaging examination (ultrasound, mammography, and MRI), and biopsy. The occurrence of fat necrosis is closely related to patient's own reason and fat transplantation technology. Optimizing the process of fat acquisition, purification, and transplantation can reduce the occurrence of fat necrosis. Intervention or not after fat necrosis depends on the nature of the nodules. According to the nature of the the nodules, various methods such as simple aspiration, vibration amplification of sound energy at resonance liposuction, or direct excision can be selected.

Conclusion

Fat necrosis after autologous fat transplantation of breast are difficult to control. How to process fat to minimize the injury and maximize the activity of grafted fat needs further researches.

The use of autologous fat grafts in breast surgery: A literature review

Autologous fat injection was first described roughly a century ago and has been used in surgery ever since. In addition to its use in many surgical fields, it is also frequently used for both aesthetic and reconstructive purposes in breast surgery. Since the application of fat grafting in breast surgery has steadily increased, studies investigating its reliability have simultaneously become increasingly common. Previous studies have reported that the use of fat grafting in breast surgery is reliable, but some pending questions remain about its routine use. In order to use fat grafts successfully in breast surgery, it is necessary to be familiar with the structure and content of adipose tissue, the efficacy of adipose stem cell-enriched fat grafts, the oncological safety of fat grafts, and the problems that may occur in the radiological follow-up of patients who undergo fat grafting procedures. In this literature review, we aim to discuss the use of fat grafts in breast surgery by investigating these common problems.

International Expert Panel Consensus on Fat Grafting of the Breast

Background

Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the authors of this study have organized a Survey and an International Consensus Conference that was held at the Aesthetic Breast Meeting in Milan (December 15, 2018).

Methods

All studies on fat grafting, both for breast aesthetic and reconstructive purposes, were electronically screened. The literature review led to 17 "key questions" that were used for the Survey. The authors prepared a set of 10 "key statements" that have been discussed in a dedicated face-to-face session during the meeting.

Results

The 10 key statements addressed all the most debated topics on fat grafting of the breast. Levels of evidence for the key statements ranged from III to IV with 2 statements (20%) supported by a level of evidence III and 6 statements (60%) by level of evidence IV. Overall consensus was reached for 2 statements (20%) with >75% agreement reached for 7 statements.

Conclusions

The survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.

The Vacuum-Assisted Breast Biopsy System is an Effective Treatment Strategy for Breast Lumps After Augmentation with Autologous Fat Grafting

BACKGROUND

With the extensive application of autologous fat grafting (AFG) to the breasts, postoperative complications such as breast lumps attract high attention. Breast lumps greatly reduce patient satisfaction and bring mental stress. However, there are few detailed reports about minimally invasive treatment strategies for breast lumps after AFG. Our study aimed to investigate the effectiveness of the vacuum-assisted breast biopsy (VABB) system for patients with lumps after AFG.

MATERIALS AND METHODS

We retrospectively reviewed 37 patients with breast lumps between April 2015 and January 2019. The characteristics of patients and breast lumps were analyzed. Breast lumps were classified into four types, including cystic, solid, complex and calcification. The vacuum-assisted breast biopsy (Mammotome and Encor) was performed for the patients with lumps after AFG. The efficacy, safety, complications and patient satisfactions were recorded during postoperative follow-up periods.

RESULTS

Under the guidance of ultrasound, the breast lumps could be thoroughly and accurately excised by the vacuum-assisted biopsy system. No patient experienced breast infections or major complications requiring treatment. Hematoma was observed in only 2 patients and gradually resolved without any special management. With a median follow-up of 29 months, no recurrence was observed. Furthermore, there were no statistical differences in duration of the procedures and complications between the two VABB systems. All the patients recovered well and were satisfied with the cosmetic outcome.

CONCLUSION

The vacuum-assisted breast biopsy system can be used as an effective and minimally invasive approach for the surgical management of lumps after AFG.

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 .

Effects of Platelet-Rich Plasma on Fat and Nanofat Survival: An Experimental Study on Mice

BACKGROUND

Nanofat and fat graft survival is an important clinical problem. The authors of this study investigated whether PRP has an impact on fat and nanofat graft survival and vascularization in a mouse model.

MATERIALS AND METHODS

Fat was harvested from a 50-year-old healthy woman by vacuum suction, and nanofat was obtained by emulsification and centrifugation procedures. PRP was collected after two rounds of centrifugation from an autologous blood sample. Twenty male nude mice were divided into four treatment groups: PRP/nanofat, PRP/fat, saline/nanofat and saline/fat. After 1 month and 3 months, the grafts were extracted and weighed. The microstructure of the fat and nanofat was examined with a scanning electron microscope. HE and immunohistochemical staining was applied to observe neovascularization. Western blot analysis was used to analyse the expression of CD31 and VEGF.

RESULTS

In fat tissue, fat cells had normal connections; the fat structure was complete and fibre networks were visible. In nanofat, the extracellular matrix vascular components were visible and their structures were intact. At 1 month and 3 months, the graft weights in the PRP/fat group were significantly higher than those in the other groups. Further, a higher degree of neovascularization was observed in the PRP/nanofat group, and the expression of CD31 and VEGF in the PRP/nanofat group was higher than that in the other groups.

CONCLUSION

PRP can promote nanofat and fat graft survival and vascularization.

NO LEVEL ASSIGNED

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

Long-term clinical results and quality of life in patients undergoing autologous fat transplantation for breast augmentation using the BEAULI™ protocol

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.

From Bedside to Bench: The Effect of Muscular Denervation on Fat Grafting to the Breast by Comparing Take Rate, Quality, and Longevity

BACKGROUND

Autologous fat grafting (AFG) to the breast is a frequent procedure in aesthetic and reconstructive surgery. Despite pure volume gain, questions remain regarding the engraftment rate, quality, and longevity. Little is known about the role of recipient tissue or innervation of the grafted area.

OBJECTIVES

The goal of this study was to determine the optimal recipient layer and muscular pretreatment of AFG.

METHODS

Fat was grafted to the breast, pectoralis muscle, or adjacent subcutaneous tissue of 42 rats. Nerve treatment included excision of a nerve segment, botulinum toxin (BTX) injection, or no treatment. Magnetic resonance imaging (MRI) and histological workup were carried out after 2 and 6 weeks.

RESULTS

Six weeks after AFG, the proportion of viable fat cells within the grafted fat stayed high (median, [IQR]: 81% [72% to 85%]). The signs of inflammation decreased over time. Intramuscular grafting with intact nerves had a decreasing effect on the viability of the grafted cells compared with subcutaneous treatment (-10.21%; 95% confidence interval [-21.1 to 0.68]).

CONCLUSIONS

If utilized on an intact nerve, intramuscular injection may lead to inferior results. If the nerve was cut or treated with BTX; however, intramuscular injection tends to be superior. These findings may prove interesting for future studies and eventual clinical application.

Ultrasound Diagnosis and Treatment of Breast Lumps after Breast Augmentation with Autologous Fat Grafting

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.

Autologous fat transfer for breast surgery

Cosmetic and reconstructive surgeries always have a primary aim of the best outcome for the patient, with a big emphasis on the aesthetics. Lipomodelling is one such technique, originally described over a century ago but still used to this day, to provide a patient with the highest quality results. This is particularly true for lipomodelling of the breast, whether it be purely cosmetic, or for a post-mastectomy reconstruction for a breast cancer patient. Lipomodelling provides an effective way of restoring and even improving the look and aesthetics of the breast and of helping achieve the patient's expectations. With the added advantage of being autologous, the procedure is safe and effective. This review discusses the latest guidelines and literature on autologous lipomodelling.

[Soft tissues volumes changing in malar and cheek area after fat grafting]

To improve the predictability of facial soft tissues fat grafting results tissue thickness dynamics before and 1 year postoperatively was assessed by means of ultrasonic method in 58 patients under standardized position of the ultrasonic transducer, physical and technical scanning conditions. The study revealed direct correlation of soft tissues thickness increase after fat grafting with the initial thickness of recipient area tissues. One year after fat grafting 60-65% of additional thickness remained in the lower regions of malar-cheek area (with the greatest soft tissues thickness), and only 25-27% preserved in the upper regions with the minimal initial thickness of soft tissues. I.e. to achieve necessary correction volume in a zone with small initial soft tissues thickness it is necessary to increase the amount of fat grafting stages. As the rates of soft tissues thickness in correction area change during 3-4 months after fat grafting remaining stable after this period it is expedient to assess postoperative results and to carry out repeated fat grafting not earlier than 4 months after operation.

Occurrence of Breast Mucinous Carcinoma After Autologous Fat Grating for Breast Augmentation

Autologous fat grafting is commonly performed in reconstructive breast surgery as well as in aesthetic breast augmentation surgery. Nevertheless, little is known about the interaction between fat grafts and cancer. A 36-year-old patient had undergone bilateral breast augmentation with autologous fat grafting. Two months after surgery, she perceived two small palpable indurations in the right breast. Nine months after the procedure, the lumps grew bigger and lumpectomy was performed. Histologic examination of the specimens showed mucinous carcinoma of the breast. This case raises once again the question about the possible links between breast cancer and fat grafts. The level of evidence is level V.

NO LEVEL ASSIGNED

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

Fast and simple fat grafting of the breast

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.

Treatment of Skin Depression with Combined Upward Suture Traction and Percutaneous Subcision

Scar retraction and soft-tissue depression may compromise aesthetics and cause social embarrassment. The purpose of this study was to evaluate the results of treating soft-tissue depressions or retractions at varied anatomy regions with combined upward suture traction and percutaneous subcision.

Breast Auto-Augmentation: A Versatile Method of Breast Rehabilitation-A Retrospective Series of 107 Procedures

Background

Breast auto-augmentation (BAA) using an inferior pedicle dermoglandular flap aims to redistribute the breast tissue in order to increase the fullness in the upper pole and enhance the central projection of the breast at the time of mastopexy in women who want to avoid implants. The procedure achieves mastopexy and an increase in breast volume.

Methods

Between 2003 and 2014, 107 BAA procedures were performed in 53 patients (51 bilateral, 2 unilateral and 3 reoperations) with primary or secondary ptosis of the breast associated with loss of fullness in the upper pole (n=45) or undergoing explantation combined with capsulectomy (n=8). Six patients (11.3%) had prior mastopexy and 2 (3.7%) patients had prior reduction mammoplasty. The mean patients' age was 41 years (range, 19-66 years). All patients had preoperative and postoperative photographs and careful preoperative markings. Follow-up ranged from 6 months to 9 years (mean, 6.6 months).

Results

The range of elevation of the nipple was from 6 to 12 cm (mean, 8 cm). The wounds healed completely with no complications in 50 (94.3%) patients. Three patients had complications including 2 (3.7%) hematomas and 1 (1.9%) partial necrosis of the nipple-areola complex. Three (5.7%) patients were dissatisfied with the level of mastopexy achieved underwent a further procedure. No patient complained of scar hypertrophy.

Conclusions

BAA is a versatile technique for women with small breasts associated with primary or secondary ptosis. It is also an effective technique for the salvage of breasts after capsulectomy and explantation.

Progressive fat necrosis after breast augmentation with autologous lipotransfer: a cause of long-lasting high Fever and axillary lymph node enlargement

Breast augmentation with autologous fat transfer has been widely practiced. However, this procedure is not exempt from complications even after technique refinement. This article aims to describe a case of long-lasting high fever, axillary node enlargement, and upper extremity dysfunction caused by liponecrosis after breast fat injection. Radiological and histological examination confirmed liponecrosis in bilateral breasts. Aspiration, drainage, and irrigation were performed along with empirical antibiotic treatment. The patient has made a full recovery from the operation. Liponecrosis, one of the complications after autologous fat grafting to the breast, may present widely different symptoms and signs. Even experienced surgeons should not underestimate it and caution should be used to maintain safety during and after the procedure.

LEVEL OF EVIDENCE V

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

Autologous fat grafting for cosmetic breast augmentation: a systematic review

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.

Cosmetic fat augmentation following breast reconstruction: sonographic appearance with cytopathologic correlation

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.

Dystrophic calcifications after autologous fat injection on face

Autologous fat injection is widely used procedure for various functional and aesthetic purposes. However, it could result in many immediate or delayed complications including dystrophic calcifications. Almost all of the case reports about dystrophic calcification after autologous fat injection were result from the iatrogenic tissue trauma of breast augmentation. This is a report of a 30-year-old patient who developed pathologically proven multiple dystrophic calcifications on the face after autologous fat injection.

Arm dynamic definition by liposculpture and fat grafting

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.

Dynamic-definition male pectoral reshaping and enhancement in slim, athletic, obese, and gynecomastic patients through selective fat removal and grafting

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.

Applicability and safety of autologous fat for reconstruction of the breast

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.

Bilateral liponecrotic pseudocysts after breast augmentation by fat injection: a case report

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.

Autologous fat grafting for primary breast augmentation: a systematic review

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.

The augmented breast: a pictorial review of the abnormal and unusual

OBJECTIVE

This article reviews the multimodality imaging features of breast augmentation complications as well as appearances of unusual breast augmentation techniques.

CONCLUSION

Cosmetic breast augmentation is an increasingly common procedure performed in our society. Although breast prosthesis implantation is the most common technique, other unusual techniques such as autologous fat implantation as well as direct liquid silicone and paraffin injections have also been used.

Oncologic risks of autologous fat grafting to the breast

As the frequency of fat grafting to the breast has increased, some investigators have raised the possibility that this procedure may potentially increase the risks associated with breast cancer. Their concerns included not only interference with cancer detection, but also promotion of tumor formation or recurrence mediated by mechanisms such as aromatase expression, angiogenesis, and tumor stromal cells. However, published clinical studies describing outcomes of fat grafting to the breast in more than 2000 patients have not reported any increase in new or recurrent cancers. The reason for this apparent disconnect may lie in the small sample sizes and relatively short follow-up, but it may also reside in the considerable gap between laboratory studies or theoretical considerations suggesting potential risks and the actual clinical practice. This review discusses potential risks of current and novel approaches to autologous fat grafting to the breast within the context of both the underlying science and clinical practice.

Autogenous fat grafting and breast augmentation: a review of the literature

Since the 1980s, there has been an increased interest in autogenous fat grafting for breast augmentation. However, concerns over graft survival and interference with breast cancer screening have limited its application. Since its introduction, refinements in harvesting and grafting techniques have improved results. The available literature consists primarily of case reports and series. There are no controlled trials, and outcomes thus far have not been measured in a standardized way. The limited data relating to breast cancer screening did not note a significant interference. Concerns have been raised that the placement of mature adipocytes and adipocyte-derived stem cells into the hormonally-active environment of the breast may potentiate breast cancer, but there are no clinical trials that investigate this possibility and a consensus regarding the basic science is still developing. Large multicenter, controlled, prospective trials are necessary to further investigate the many issues relating to the application of autogenous fat grafting for augmentation of the breast.