Abstract
BackgroundOur goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability.MethodsThe study included 15 women with a mean age of 31.8 years (range 23–39 years) who underwent breast asymmetry correction with AFG harvested from both thighs. One thigh was infiltrated with a standard tumescent fluid (control graft) and other with a NAC-enriched tumescent fluid (NAC-treated graft). Each participant had breast MRI imaging before and 6 months after the procedure. Also, adipose tissue samples from each graft were subjected to biochemical analysis, flow cytometric assay and qRT-PCR to determine the markers of oxidative stress, angiogenesis and adipogenesis.ResultsConcentration and activity of superoxide dismutase in the NAC-treated grafts turned out to be significantly higher than in the control grafts, in both fresh (p = 0.041 and p = 0.023, respectively) and frozen samples (p = 0.004 and p = 0.003, respectively). The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). iNOS was the only qRT-PCR target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027). Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, although it was found to be statistically insignificant (p = 0.149). No postoperative complications were observed during a 6-month follow-up.ConclusionsSome results of this study are promising. Further studies on larger groups are needed to determine NAC impact on AFG.Level of Evidence IVThis 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.Trial registry nameThe Impact of N-Acetylcysteine on Volumetric Retention of Autologous Fat Graft for Breast Asymmetry Correction.Registration identification numberNCT03197103.URL for the registryhttps://clinicaltrials.gov/ct2/show/NCT03197103?term=acetylcysteine&rank=6
Highlights
Over the recent 20 years, autologous fat grafting (AFG) has become a widely recognized and applied technique in both aesthetic and reconstructive surgeries [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15]
The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). Inducible NO synthase (iNOS) was the only quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027)
Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, it was found to be statistically insignificant (p = 0.149)
Summary
Over the recent 20 years, autologous fat grafting (AFG) has become a widely recognized and applied technique in both aesthetic and reconstructive surgeries [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15]. Adherence to the principles of fat grafting should be reflected by constant, low retention rates [22] This clinical issue could be partially solved with additional grafting procedures or overcorrection. Many previous studies demonstrated that a compensation of expected volume retention via overcorrection may result in unfavorable graft-to-recipient interface [23]. This is associated with the increased risk of oil cyst and fibrotic scar tissue formation and fat necrosis, which eventually leads to an even greater resorption rate and unfavorable esthetic outcomes [7, 23,24,25,26]. Our goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability
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