Fat Grafting For Breast Augmentation Research Articles

Strategies to perform autologous fat grafting for breast augmentation in underweight women

Strategies to perform autologous fat grafting for breast augmentation in underweight women

Fat Grafting Versus Implants: Who's Happier? A Systematic Review and Meta-analysis

Background: Breast implants were first introduced in the 1960s and have long been used for augmentation and reconstructive breast surgery. More recently, fat grafting for breast augmentation has gained popularity due to the ‘natural’ outcome and lack of implant-related complications. The aim of this study was to conduct a systematic review and meta-analysis comparing patient-related outcome measures between fat grafting and implant-based primary augmentation using the validated BREAST-Q questionnaire. Methods: A systematic review of the literature according to the PRISMA guidelines was conducted in PubMed®, Cochrane Library®, EMBASE®, MEDLINE®, and Scopus® databases. Papers were screened by two independent blinded reviewers. Quality was assessed using MINORS criteria. Results: Fourteen studies were included in the meta-analysis representing a total of 81 fat grafting augmentations and 1535 implant augmentations. The average overall patient satisfaction mean post-operative scores were 13.0 points higher in the implant group based on meta-regression (95% CI: 2.4-23.5; P = .016). There was no statistical difference in reported post-operative sexual well-being, psychosocial well-being, or physical well-being BREAST-Q scores. Conclusion: Although implant-based augmentation resulted in higher post-operative overall satisfaction scores, fat grafting remains a highly desirable alternative for augmentation in the right patient. This meta-analysis strongly highlights that careful patient selection and evaluation of patient goals must be assessed when selecting an augmentation method.

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

The complications of large-volume fat grafting (LVFG) for breast augmentation remain unpredictable and include palpable breast nodules, oil cysts, and calcifications. This study was aimed to provide an optimal treatment option for breast nodules after LVFG and evaluate their pathological characteristics. 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. 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. 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.

Fat Grafting With Expanded Adipose-Derived Stromal Cells for Breast Augmentation: A Randomized Controlled Trial.

The main challenge with fat grafting is loss of some of the graft to postsurgery resorption. Previous studies suggest that adipose-derived stromal cells (ASCs) can improve the volume retention of fat grafts but there is a lack of randomized trials to support the use of ASCs in clinical practice. This trial aimed to investigate whether ASCs improve fat graft volume retention in patients undergoing breast augmentation with lipofilling. This was a double-blind, randomized controlled trial of breast augmentation with ASC-enriched fat grafting. Healthy women aged 30 to 45 years were enrolled. First, the participants underwent liposuction to obtain fat for culture expansion of ASCs. Then, the participants were randomly assigned to undergo a 300- to 350-mL breast augmentation with ASC-enriched fat grafting (10 × 106 ASCs/mL fat graft) to 1 of their breasts and placebo-enriched fat grafting of identical volume to the contralateral breast. The primary outcome was fat graft volume retention after a 1-year follow-up measured with MRI. The trial is registered at www.clinicaltrialsregister.eu (EudraCT-2014-000510-59). Ten participants were included in the trial; all completed the treatment and follow-up. No serious adverse events occurred. Fat graft volume retention after 1 year was 54.0% (95% CI, 30.4%-77.6%) in the breasts treated with ASC-enriched fat grafting (n = 10) and 55.9% (95% CI, 28.9%-82.9%) in the contralateral breasts treated with placebo-enriched fat grafting (n = 10) (P = 0.566). The findings of this trial do not support that ASC-enriched fat grafting is superior to standard fat grafting for breast augmentation.

Safety and Effectiveness of Single Session Mega Volume Fat Grafting for Breast Augmentation: A Space-Creating Concept and Clinical Experiences.

The main drawback of fat transfer breast augmentation is the need for multiple sessions of fat injection. For approximately 15 years, stem cells and the Brava device for breast expansion have been discussed and extensively investigated to address relevant challenges. However, the safety and effectiveness of autologous fat transfer as a single-session primary breast augmentation technique has not yet been standardized. The aim of this study was to achieve mega volume fat breast augmentation in a single session by developing a "space-creating" approach that emphasizes the use of highly purified fat to achieve an optimized surgical outcome with large-volume breast augmentation. Female patients who underwent aesthetic breast augmentation (October 2013-October 2020) involving the application of this space-creating technique for mega volume autologous fat transfer were retrospectively enrolled. Inclusion criteria were patients with hypomastia, breast asymmetry, and volume replacement following implant removal with BMI ≥18.5 kg/m2. After macrospace creation, highly purified fat was injected in several rounds during the procedure. A breast massage was performed between each stage (microspace creation). Breast circumference, nipple-inframammary fold distance, and cup size were recorded during 6 months of follow-up. Three hundred fifty-eight patients met the inclusion criteria. Average fat injection volumes of 510.9 mL in the right breast and 490.8 mL in the left breast resulted in at least a 2 cup size increase. The significant outcome remained stable at 6 months after surgery. The space-creating technique and the injection of highly purified fat achieves stable cosmetic outcomes of mega volume breast augmentation in a single session.

The Effect of Arm Position on Breast Volume Measurement Using Three-dimensional Imaging.

Three-dimensional (3D) imaging offers an objective and quantitative way to evaluate the breast volume. In this study, we aimed to investigate whether arm position can be a factor influencing the measurement of breast volume and which arm position is more stable when using 3D breast imaging in evaluating the fat volume retention rate in autologous fat grafting for breast augmentation. Patients undergoing breast augmentation with autologous fat grafting in our department were selected for the first part of this study. Preoperative 3D breast imaging was performed at three different arm positions: at the sides, akimbo and with hands on the head. Scans on each arm position were repeated on the first day after surgery, taking six scans in total. Breast volume change (BVC) was compared before and after surgery. The patients planning to receive bilateral mammaplasty in our department were selected for the second part of this study. Two repeated 3D scans were performed at the sides, akimbo and hands on the head, and then, the breast volume change error (BVCE) was compared. Twenty-five patients (n = 50 breasts) were included in the first part of study. For the patients who received 100-200ml fat injection, compared with hands on the head, a statistically significant difference in the average BVC was found at the sides and akimbo (p = 0.02). For the patients receiving more than 200ml fat injection, there was no statistically significant difference between the groups (p > 0.05). Twenty-six patients (n = 52 breasts) were enrolled in the second part. For the average BVCE, there was no significant difference between the groups (p = 0.11). The arm position during 3D breast imaging, to some extent, affects the evaluation of BVC after breast augmentation using autologous fat grafting, particularly for patients receiving less fat grafting. The arm position should be kept consistent when using 3D breast imaging in evaluating the fat volume retention rate. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.

Methods used for evaluation of volume retention rate in autologous fat grafting for breast augmentation: a systematic review.

Autologous fat grafting has gained popularity in breast augmentation. Various methods can be used to estimate the volume retention rate. This systematic review aimed to establish whether the type of method used for measuring breast volume is a factor that influences the reported volume retention rate. Studies were identified using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception of the database up to February 2019. Articles describing autologous fat grafting for breast augmentation were selected based on pre-determined inclusion and exclusion criteria. The characteristics of the included studies were summarized, and the reported volume retention rate from the studies was compared. A quality assessment of all included articles was performed using the methodological index for non-randomized studies criteria. A total of 618 articles were identified, of which 12 studies, with a total of 1337 cases, were eligible. The retention rate of injected adipose tissue varied when the method of fat grafting and volume analysis used were both the same, as well as when the method of fat grafting was the same but the method of volumetric evaluation used was different. Currently, the tools available for estimating the volume retention rate come with limitations. In order to objectively evaluate the percentage of graft retention, a standard protocol that applies to the different methods should be established in the future.

Clinical application and effects of two different liposuction methods in breast augmentation by autologous fat grafting

Objective To explore the effect of different harvest methods of liposuction on the autologous fat grafting. Methods The clinical data of 60 patients with fat grafting for breast augmentation from January 2014 to January 2017 were analyzed retrospectively. According to the method of liposuction, 60 patients were divided into the water-jet assisted liposuction group (30 cases) and negative-pressure machine liposuction group (30 cases). The surgical time of different liposuctions and the fat survival were compared after breast augmentation. The clinical effect of different liposuction methods was analyzed by follow-up one year after operation. Results Sixty patients completed the surgery. The fat survival rate of water-jet assisted liposuction was (66.71±2.68)%, and the fat survival rate of the negative-pressure machine liposuction was (51.44±1.16)%. There were statistically significant difference between the two groups (P 0.05). Conclusions Compared with negative pressure liposuction, water-jet assisted liposuction using autologous fat grafting in breast augmentation can improve the survival rate of fat transplantation. This technique has good clinical application value. Key words: Transplantation, autologous; Fats; Breast; Negative-pressure liposuction; Water-jet assisted liposuction

Application of autologous fat grafting in breast augmentation

Objective To report our experience of breast augmentation patients with fat grafting. Methods The treatment of 560 patients with fat grafting for breast augmentation was summarized in our hospital from Jan. 2011 to Dec. 2015. Fat was harvested using low negative pressure liposuction technique with 3-hole blunt cannula (diameter 2.5 mm). The fat was managed using cotton pad for concentration of fat tissue and separating them from fluids, oil, and debris. A diameter 2.5 mm, 1-hole blunt cannula was used to place the fat through 3-mm incision on inframammary fold, fat grafting with multi-level and multi-tunnel and multi-point injection ways, regularly taking picture for imaging evaluation. Results All patients were successfully performed with breast augmentation, and no severe complications occurred. Grafted fat volume ranged from 180 to 400 ml (average, 235 ml) per breast. Most of women had a significant improvement in their breast size and shape postoperatively, and the breasts were soft and natural in appearance. The patients were followed up for 18-24 months, and the outcome were satisfactory. Conclusions Autologous fat grafting for breast augmentation simplifies the operation procedure with satisfied results (natural breast and body contouring) and avoids the complications of breast prosthetic procedures. Key words: Transplantation, autologous; Fats; Injections; Surgical sponges; Breast augmentation

How to Objectively Evaluate Nodule Complications and Volume Changes After Fat Grafting in Breast Augmentation.

How to Objectively Evaluate Nodule Complications and Volume Changes After Fat Grafting in Breast Augmentation.

Response to "How to Objectively Evaluate Nodule Complications and Volume Changes After Fat Grafting in Breast Augmentation".

Response to "How to Objectively Evaluate Nodule Complications and Volume Changes After Fat Grafting in Breast Augmentation".

Complications of Fat Transfer for Breast Augmentation

Autologous fat grafting is quite common for breast augmentations as well as for reconstructive breast surgery. Coleman has described the surgical technique of fat grafting. Fat is harvested, and after centrifugation and refinement, blunt infiltration cannulas are used to place the fat through small incisions. The grafted tissue is placed in small aliquots with each withdrawal of the cannula. In order to achieve an aesthetically pleasing contour of the breast, the fat should be layered into different levels from the chest wall to the skin. However, autogenous lipotransfer if not performed lege artis might lead to complications such as fat necrosis, calcification, formation of encapsulated fatty masses (cystic lesions), lymphadenopathy, disfigurement of breast contouring, hypersensitive breasts, itchy nipples. A 36-year old female patient, presented with multiple palpable cystic lesions, disrupted breast contouring, asymmetry, hypersensation and pain during examination, 6months after autologous fat grafting for breast augmentation elsewhere. The patient had ultrasound and MRI screening, which revealed the multiple bilateral cysts formation in the breast tissue. Surgical removal of the large lesions was performed, and specimens were sent for pathology and cytology consideration and screening. A few months after surgical removal of these lesions and after symptoms subsided, breast augmentation was performed with silicone implants. An aesthetically pleasing result together with relief of the patient's initial symptomatology was achieved. 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 .

Influences of improved low negative pressure mechanical liposuction and syringe liposuction on breast augmentation by autologous fat grafting

Objective To investgate the efficiency of autologous fat grafting for breast augmentation by improving low negative pressure mechanical liposuction. Methods A total of 37 cases of breast augmentation by autologous fat grafting were reviewed; group A included 19 cases of improved low pressure mechanical liposuction, and group B had 18 cases of traditional syringe liposuction. Respectively, the operating time of harvesting 800 ml fat granules (standing 30 mins) were recorded, and operative blood loss by testing the red blood cell count of lower mixed liquid was calculated, and then growth increment of nipple chest circumference of 6 months after operation were measured. The valid follow-up satisfaction scores were counted. Results The operating time of harvesting 800 ml fat granules were (53.32±4.73) mins for group A and (80.78±7.86) mins for group B, respectively; operative blood loss was (81.58±10.80) ml for group A and (72.94±13.45) ml for group B; All P<0.05. The valid follow-up satisfaction scores were 78.9% (15/19) for group A and 77.7% (14/19) for group B. Growth increment of nipple chest circumference of 6 months after operation between groups were no statistical significance (P0.05); but the remarkable difference within both groups in internal comparison existed between 6 months and 1 month after operation (P<0.05), also between 3 months and 1 month after operation (P<0.05). Conclusions Improved low pressure mechanical liposuction in breast augmentation by autologous fat grafting is able to enhance the surgical efficiency evidently and shorten the operating time significantly. Key words: Fat grafting, autologous; Breast augmentation; Liposuction

Correction with autologous fat grafting for contour changes of the breasts after implant removal in Asian women

Patients who were diagnosed with symptomatic capsular contracture or with safety concerns for the implant would be often reluctant to accept the operation of implant exchange, choosing instead removal without exchange or taking other options to rebuild their breasts. These patients may benefit from augmenting the overlying soft tissue of the breasts with autologous fat grafting after removing the prosthesis. A retrospective analysis of the patients receiving fat grafting for breast augmentation after implant removal was performed in this study. Between March 2011 and November 2013, 27 patients receiving autologous fat grafting after breast implant removal. Objective evaluation was made by measuring the change in breast thickness with ultrasonography taken before and after the treatment. Aesthetic evaluation was performed using a 5-point Likert scale for patient satisfaction and comparing preoperative and postoperative digital photographs for physician satisfaction. The mean breast thickness change was 13.1 mm (SD = 3.3) which was an increment by 154% in comparison to the averaged breast thickness of 8.5 mm after implant removal. The results of patient satisfaction and physician satisfaction were 16.3 (SD = 1.2) and 16.7 (SD = 1.6). Complications included recipient site infection, fat necrosis, and small areas of induration. The overall complication rate was 22.2% (6 of 27). Autologous fat grafting is beneficial for the correction of deformed breasts after implant removal. With its preferential fill qualities, the wide cleavage and excessive upper pole fullness associated with existing implants can also be corrected.

Autologous fat grafting for breast augmentation in underweight women.

In recent years, there have been reports of success with autologous fat grafting to the breast for cosmetic breast enhancement. However, the procedure is generally contraindicated in women who are underweight (body mass index [BMI]<18.5). The author sought to determine the safety and success rate of autologous fat grafting for breast augmentation in underweight women. Patients who underwent breast augmentation with autologous fat grafting and had adequate follow-up time (≥12 months) were assigned to group A (BMI>18.5) or group B (BMI≤18.5; underweight). A retrospective analysis was performed to compare the safety and effectiveness of fat grafting between the study groups. Relative to group A, patients in group B were younger and had smaller differences in breast circumference (BCD) both pretreatment and posttreatment. The volume of injected fat was significantly smaller in group B. The differences in posttreatment complication rates and changes in BCD were not statistically significant between the study groups. The same degree of breast enlargement was achieved in both study groups after autologous fat grafting for breast augmentation. The rate of posttreatment complications was not higher for underweight women. Therefore, it appears that BMI≤18.5 is not a contraindication for this procedure. 4.

A “Solid Injection Method” to Reduce Postoperative Complications in Autologous Fat Grafting for Breast Augmentation

Introduction: Over the last decades, there has been an increasing interest in breast augmentation using autologous fat transplantation for reconstructive and cosmetic purposes. However, autologous fat graft to the breast is not a simple procedure and should be performed only by well-trained and skilled surgeons. The rate of postoperative complications is reported in the literature to be 10–16.7%. To reduce complications in autologous fat graft to the breast, the author developed a solid injection method to increase the contact area of the grafted fat and the recipient tissue. Materials and Methods: From May 2010 to February 2012, we performed autologous fat grafting for 281 patients. After exclusion of the patients with inadequate follow-up time (&lt;6 months) or who were lost to follow-up, 190 patients were enrolled in this study. The enrolled patients were randomly divided into group A, in which structural fat grafting was done by the method described by Coleman, and group B, in which the solid injection method was administered. For the solid injection method, the operator used his nondominant hand to compress the breast to increase the contact area with the injected fat when performing the fat graft injection. At the end of the fat injection, the breasts were still soft, and there was no pressure leakage from the entries. The data between the 2 groups was analyzed using a two-sample t test, and the complication rates were analyzed using a chi-square test. Results: The age of the patients ranged from 21 to 57 years (mean = 34 years). The volume of fat harvested was 776 mL to 5050 mL (mean = 1593 mL), and the volume of fat grafted to each breast was 120 to 310 mL (mean = 246 mL). There were 56 patients enrolled in group A and 134 patients enrolled in group B. All patients were followed up from 7 to 28 months, with an average of 15.1 months postoperatively. The differences of patient data in both groups were statistically insignificant. Postoperative complication rates were 14.2% in group A and 2.2% in group B, the difference of which is statistically significant (P = .001). Conclusions: The solid injection method can reduce postoperative complications in autologous fat grafting. There were 4 principles to be followed in this method: Principle I, the fat should be injected only into an area with “solid” feedback while processing the injection; Principle II, the fat should never be injected into an empty area; Principle III, the breasts should be soft at the end of injection; and Principle IV, there should be no/minimal pressure leakage from the entries after the injection.

Study of the effect of platelet rich plasma (PRP) on structural fat grafting for breast augmentation

Introduction: Lipoinjection can be used to give extra-volume during breast enhancement surgeries and to coect various types of depressed deformities of the breast, but certain problems remain as unpredictability and low graft survival which are a major concern in plastic surgery. Different trials and techniques were done for enhancement of the take and vascularity of the fat grafting. Platelet Rich plasma plays an important role in the process of vascularization of the grafted fat due to its high content of Platelet Derived Growth Factor(PDGF). Methods: 20 patients who were candidates for breast augmentation were included in the study and were divided into two groups; one had fat injection with PRP in the breast and the other had breast lipoinjection with Colemantechnique. A questionnaire follow up was designed on Likert scale on grades 0-4 evaluating the volume and fat survival with statistical analysis. Results: Group B (with PRP) showed overall better results. All patients with PRP showed moderate to good projection post-operatively. 50% of Group B showed no further requirement of secondary procedure. Whereas group A showed moderate to large requirement for secondary augmentation. Conclusion: The increase in the level of PRP and in turn PDGF during the first days after lipoinjection will enhance the graft vascularity and overall survival, thus there is a need to further studies for standardizing the level of PDGF needed to have better take & results with lipoinjection.

Breast Augmentation Using Preexpansion and Autologous Fat Transplantation: A Clinical Radiographic Study

Despite the increased popularity of fat grafting of the breasts, there remain unanswered questions. There is currently no standard for technique or data regarding long-term volume maintenance with this procedure. Because of the sensitive nature of breast tissue, there is a need for radiographic evaluation, focusing on volume maintenance and on tissue viability. This study was designed to quantify the long-term volume maintenance of mature adipocyte fat grafting for breast augmentation using recipient-site preexpansion. This is a prospective examination of 25 patients in 46 breasts treated with fat grafting for breast augmentation from 2007 to 2009. Indications included micromastia, postexplantation deformity, tuberous breast deformity, and Poland syndrome. Preexpansion using the BRAVA device was used in all patients. Fat was processed using low-g-force centrifugation. Patients had preoperative and 6-month postoperative three-dimensional volumetric imaging and/or magnetic resonance imaging to quantify breast volume. All women had a significant increase in breast volume (range, 60 to 200 percent) at 6 months, as determined by magnetic resonance imaging (n = 12), and all had breasts that were soft and natural in appearance and feel. Magnetic resonance imaging examinations postoperatively revealed no new oil cysts or breast masses. Preexpansion of the breast allows for megavolume (>300 cc) grafting with reproducible, long-lasting results that can be achieved in less than 2 hours. These data can serve as a benchmark with which to evaluate the safety and efficacy of other core technology strategies in fat grafting. The authors believe preexpansion is useful for successful megavolume fat grafting to the breast.

Autologous Cell-Enriched Fat Grafting for Breast Augmentation

Autologous fat grafting for breast augmentation has faced some historical hurdles. However, in recent years it has been gaining acceptance from the medical community. This prospective, nonrandomized open-label study of 20 Japanese women supports the use of autologous fat grafting in breast augmentation and explores enhancement of fat graft tissue with autologous adipose-derived regenerative cells (ADRCs). After adipose harvesting using syringe liposuction, the tissue is processed in the Celution 800 System(®), which washes the graft and isolates ADRCs. The average cells per gram of harvested adipose tissue was 3.42×10(5), and the mean cell viability measured using an automated cell counting system before graft delivery was 85.3%. All patients demonstrated improvement in circumferential breast measurement (BRM) from their baseline state, and breast measurements were stable by 3months after surgery. The mean BRM 9months after surgery had increased 3.3cm from preoperative measurements. Through 9months, overall physician satisfaction was 69% and patient satisfaction was 75%. No serious or unexpected adverse events were reported, and the procedure was safe and well tolerated in all patients. Postoperative cyst formation was seen in two patients. These prospective results demonstrate that ADRC-enriched fat grafts processed with a closed automated system maintain high cell viability and that the procedure is safe and effective, with all patients showing improvement after a single treatment.

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.