The science behind autologous fat grafting

Abstract

IntroductionAdipose grafting has undergone significant changes over time. Many different techniques have been followed by trying to improve the quality of the lipoaspirate and the survival of the fat graft after implantation.Material and methodsThe purpose of this review is to analyse the historical evolution of the surgical harvesting and implant technique, describing the changes that have brought significant improvements, revolutionizing the aesthetic and functional results obtainable.ResultsA standard fat grafting technique is commonly performed in three stages: harvesting of adipose tissue from a suitable donor site; processing of the lipoaspirate to eliminate cellular debris, acellular oil and excess of infiltrated solution, reinjection of the purified adipose tissue. The most widely used surgical technique was described by Coleman. He modified and corrected the methods and results of his predecessors and proposed an atraumatic protocol for the treatment of adipose tissue.He reported that the key to successful fat grafting lies in the technique. In addition, he noticed that adipose tissue was not only a good filler, but improved the quality of the skin. In fact, fat grafts demonstrated to have not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue.ConclusionAdipose tissue, actually, is the closest to the ideal filler because it is readily available; easily obtainable, with low donor-site morbidity; repeatable; inexpensive; versatile; and biocompatible. There is an abundance of literature supporting the efficacy of fat grafting in both aesthetic and reconstructive cases. Recent studies have shown the utility of adipose-derived stem cells in the improvement of wound healing, describing their ability to regenerate soft tissues and their remodelling capacity provided by their unique cytokine and growth factor profiles.Despite ongoing concerns about survival and longevity of fat grafts after implantation and unpredictability of long-term outcome, fat has been successfully used as a filler in many differ clinic situation.

Skin trophicity improvement by mechanotherapy for lipofilling‐based breast reconstruction postradiation therapy

“…The complication rate was related to radiation therapy with 5.4% in the irradiated group compared with 1.1% in the nonirradiated group (considering only necrosis and ulceration). This is a significant shift from the high rate of complications associated with prosthetic reconstruction without lipofilling . Trophic skin is associated with lower fat resorption rate, better outcome, and less morbidity.…”

Tissue engineering and regenerative medicine strategies for the female breast

“…The processed tissue is then grafted onto the site of interest. Fat grafting may be a better alternative to the other therapies mentioned above, because adipose tissue is biocompatible, easy to obtain, and the procedure is repeatable and less expensive (Bellini, Grieco, & Raposio, 2017).…”

The use of fat grafting and platelet‐rich plasma for wound healing: A review of the current evidence

“…ADSCs have been shown to encourage neovascularisation and tissue regeneration in vivo . Adipose tissue has one of the highest concentrations of stem cells in the body, with approximately 5000 ADSCs per gram of fat . With regard to wound healing, the ADSCs may contribute to anti‐inflammatory and proangiogenic function through the paracrine secretion of soluble mediators .…”

“…52,56 Adipose tissue has one of the highest concentrations of stem cells in the body, with approximately 5000 ADSCs per gram of fat. 57 With regard to wound healing, the ADSCs may contribute to anti-inflammatory and proangiogenic function through the paracrine secretion of soluble mediators. 58 The SVF also contains haematopoeitic-lineage cells, mature endothelial cells, pericytes, fibroblasts, and white blood cells all of which have a role in wound healing.…”