Is There an Ideal Donor Site of Fat for Secondary Breast Reconstruction?

Small, Kevin; Choi, Mihye; Petruolo, Oriana; Lee, Christina; Karp, Nolan S.

doi:10.1177/1090820x14526751

Cited by 56 publications

(22 citation statements)

References 11 publications

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“…Fat retention was reported in 10 articles (range: 39–77%), and there was consistency in the length of time when it was measured, 14,20,23,25,26,41,43,45,46,48,54 which, in general, was after either 6 or 12 months. Fat retention was most commonly reported as an estimated volume over time as evaluated by various imaging techniques.…”

Section: Resultsmentioning

confidence: 90%

“…An average of 50% (range: 3–100%) of study participants had radiation before undergoing AFG. 14,16,21,24–28,31–41 Of the 20 studies that reported proportion of patients who underwent radiation, 3 studies reported that all patients had prior radiation therapy. 27,38,39,42 There were no observed differences in patient characteristics, surgical characteristics, or outcomes between studies that reported higher proportions of patients who received radiation compared to studies with lower rates of radiation treatment.…”

Section: Resultsmentioning

confidence: 99%

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The Safety, Effectiveness, and Efficiency of Autologous Fat Grafting in Breast Surgery

Spear

Coles²,

Leung³

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:For years, the safety and effectiveness of autologous fat grafting (AFG) for breast reconstruction have been in question, with particular concern over fat necrosis, calcifications, cyst formation, and interfering with the detection of breast cancer. However, increasing evidence suggests that the complication rates and clinical results are generally acceptable to both clinicians and patients. The emerging challenge is the numerous AFG techniques and systems, where there are limited knowledge and data. The objective of this study was to conduct a literature review that focuses on the safety, effectiveness, and efficiency of various AFG techniques as applied to the breast.Methods:A PubMed search using terms related to AFG was performed over a 5-year period (April 1, 2010–April 30, 2015). Original articles focused on AFG to the breast, with outcomes on safety, effectiveness, and efficiency, were included.Results:Five hundred ninety-eight articles were identified with 36 articles included (n = 4306 patients). Satisfaction rates were high although the prevalence of complications was low—similar to previous findings. Seven studies reported average operating room time with an overall mean of 125 minutes (range: 40–210). The mean volume of fat harvested was 558 mL (range: 120–1299), and fat injected was 145 mL (range: 20–607). A positive association between injection volume and operating time was observed.Conclusions:This review validates previous findings on the safety and effectiveness of AFG to the breast and highlights its efficiency. The efficiency data available, although limited, suggest that there is an opportunity to achieve time and cost savings while not sacrificing safety and effectiveness.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

The Safety, Effectiveness, and Efficiency of Autologous Fat Grafting in Breast Surgery

Spear

Coles²,

Leung³

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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“…23 Fat transfer for breast augmentation from the abdomen or thigh demonstrated no significant difference in fat graft volume. 24 Fat grafts formed from the thigh demonstrated greater structural integrity, less cyst formation, less necrosis, and reduced fibrosis, whereas tissue formed from abdominal adipose tissue demonstrated increased vascularity. 21 This increased structural integrity and vascularity could be attributable to greater adipose stem cell viability from the inner thigh and abdomen compared with other regions.…”

Section: Donor Sitementioning

confidence: 96%

The Current State of Fat Grafting

Strong

Cederna

Rubin

et al. 2015

Plastic and Reconstructive Surgery

340

129

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Background Interest in and acceptance of autologous fat grafting for use in contour abnormalities, breast reconstruction, and cosmetic procedures have increased. However, there are many procedural variations that alter the effectiveness of the procedure and may account for the unpredictable resorption rates observed. Methods The authors highlighted studies investigating the effects of harvesting procedures, processing techniques, and reinjection methods on the survival of fat grafts. This review focused on the impact different techniques have on outcomes observed in the following: in vitro analyses, in vivo animal experiments, and human studies. Results This systemic review revealed the current state of the literature. There was no significant difference in the outcomes of grafted fat obtained from different donor sites, different donor-site preparations, harvest technique, fat harvesting cannula size, or centrifugation speed, when tumescent solution was used. Gauze rolling was found to enhance the volume of grafted fat, and no significant difference in retention was observed following centrifugation, filtration, or sedimentation in animal experiments. In contrast, clinical studies in patients found more favorable outcomes with fat processed by centrifugation compared with sedimentation. In addition, higher retention was observed with slower reinjection speed and when introduced into less mobile areas. Conclusions There has been a substantial increase in research interest to identify methodologies for optimizing fat graft survival. Despite some differences in harvest and implantation technique in the laboratory, these findings have not translated into a universal protocol for fat grafting. Therefore, additional human studies are necessary to aid in the development of a universal protocol for clinical practice.

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“…16 Small et al also concluded that the grow-in rate is not affected by the donor zone. 17 If the transplant originates from "primary fat depots," so from diet-resistant or genetic zones, then it can be assumed that this characteristic is also maintained in the host zone. Fat cells with α2 receptors are antilipolytic and react poorly to diets.…”

Section: Donor Zonementioning

confidence: 99%

Breast Augmentation by Water-Jet Assisted Autologous Fat Grafting: A Report of 300 Operations

Muench¹

2016

Surg J

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Autologous fat transfer for breast augmentation is gaining more acceptance as an alternative to implants because only autologous filling materials are used and because undesirable fat can be removed from other regions as an additional benefit. The advantages of breast augmentation with autologous fat include the lack of reactive inflammation, foreign body reaction, and scars as well as the natural-appearing result with more volume, an improved contour, a fuller cleavage, and natural consistency.The competence and the experience of the surgeon, the technique of the extraction and processing of the fat, as well as the fat cell injection method are critical points regarding patient safety and result. Other factors are patient selection, the efficiency of the liposuction, the tumescent anesthesia, the instruments, a minimal blood loss, a high rate of survival of the transferred fat cells, and a minimal complication rate. 1 The literature varies regarding stem cell enrichment, grow-in rate, durability of the result, complications, limitations of future preventive breast exams, and possible tumor induction. Ross et al concluded in their research of 103 publications that there is no consensus regarding the optimum technique. 2 Keywords ► breast augmentation ► fat transplantation ► autologous fat graft ► liposuction ► WAL ► lipofilling AbstractBackground The BEAULI -method (Breast Augmentation by Lipotransfer) is available for extraction and processing of large transplantable fat quantities. The aim of this work is to describe the surgical technique precisely and reproducibly and to provide an overview of the autologous fat transfer based on surgical experience. Method The author performed 300 autologous fat transplantations on 254 women between September 3, 2010, and May 13, 2015. Patients desiring moderate volume increase, fuller and firmer breasts, as well as an optimization of the silhouette, ideally with the concurrent desire of the correction of unwanted fat deposits, were selected. The fat was extracted via water-jet assisted liposuction (Body-jet, Human Med AG, Schwerin, Germany), and the fat cells were subsequently separated with the Lipocollector ® (Human Med AG, Schwerin, Germany).Results The results were assessed with a control exam and photo comparison and were based on the responses on a questionnaire. Overall, 35.9% of the patients defined the result as very good, 38.6% as good, 22.4% as satisfactory, and 3.1% as poor. Conclusion This study shows that the autologous fat cell transplantation into the female breast via water-jet assisted liposuction achieves a moderate and harmoniously appearing breast volume enlargement as well as contour improvement. Further studies with more cases and longer observation periods over several years could contribute to improving the method of the autologous fat transfer regarding the grow-in rate, efficiency, and safety.

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Is There an Ideal Donor Site of Fat for Secondary Breast Reconstruction?

Abstract: Our data suggest that donor site, regardless of volume injected or tissue radiation, did not affect volume retention in fat grafting. Longer-term studies are needed to assess the stability of the breast after fat grafting.

Cited by 56 publications

References 11 publications

The Safety, Effectiveness, and Efficiency of Autologous Fat Grafting in Breast Surgery

The Safety, Effectiveness, and Efficiency of Autologous Fat Grafting in Breast Surgery

The Current State of Fat Grafting

Breast Augmentation by Water-Jet Assisted Autologous Fat Grafting: A Report of 300 Operations

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