Fat Transfer Research Articles

Role of mesenchymal cells in enhancing cosmetic outcomes for autologous augmented fat transfers for facial rejuvenation and reconstructive surgery

Role of mesenchymal cells in enhancing cosmetic outcomes for autologous augmented fat transfers for facial rejuvenation and reconstructive surgery

Cell-supplemented autologous fat grafting: a review from bench to bedside

Autologous fat grafting is routinely used in plastic and reconstructive surgery to improve contour deformities and appearance. However, retention of fat over time is inconsistent and unpredictable. Cell-assisted lipostransfer (CAL), the practice of using stem cell-containing portions of adipose to enrich fat grafts, has been found to be a promising area of research to increase not only the retention of volume but also increase collagen production, enhance angiogenesis, and direct the overall repair, remodeling, and regeneration of the recipient site. CAL, therefore, has a multitude of clinical applications, ranging from oncologic reconstruction following radiation to facial rejuvenation, among others. In this paper, we provide a comprehensive review of the current state of cell-supplemented fat transfer and discuss our understanding of cellular interactions in enriched fat grafts, techniques to improve the viability of fat, clinical translation of CAL, regulatory oversight, and future directions.

100 Autologous Fat Transfer Procedure Complications in the Emergency Department: A Public Health Crisis

100 Autologous Fat Transfer Procedure Complications in the Emergency Department: A Public Health Crisis

Evaluating the Role of Rectus Abdominis Fat Transfer (RAFT) in Improving Muscle Thickness: Does it Really Work? A 12-Month Follow-Up Cohort Study.

Looking for an adequate solution for those patients who desire abdominal definition, but are not candidates for liposuction alone, Danilla developed a technique, using selective fat grafting into the rectus abdominis (RAFT) to increase the muscle volume in addition to selective liposuction and abdominoplasty to provide an optimal body contouring. To determine whether intramuscular fat grafting in the rectus abdominis muscles leads to an increase in muscle thickness after one year. This is a prospective cohort study, from a single center, carried out over 24 months (October 2021-September 2023). Sixty-two patients who underwent lipoabdominoplasty and RAFT, had their rectus abdominis cross section measured by ultrasound pre- and 12 months postoperatively. To compare the muscle thickness, a paired t-test statistic was used. A p-value of 0.05 was considered statistically significant (IBM SPSS Statistics V26). After 1 year, all 62 patients showed an increase in the size of the rectus muscle cross section, although only 58 (94%) had fat identifiable in the US. Preoperatively, the mean muscle cross-sectional size was 1, 4cm. After RAFT, overall mean muscle cross section was 2, 3cm (0, 9cm/66.9% increase). When stratified into groups with and without identifiable fat, the group in which the graft remained showed greater increase than the group with no visible fat (69, 9% vs 19,6%). The RAFT provided a significant increase in the muscle cross section in most cases after 1 year. The presence of fat is related to a statistically significant increase in the muscle compartment (pack). 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 .

Volumetric evaluation of autologous fat transfer for total breast reconstruction

BackgroundReconstructive surgeons have shifted from correcting contour irregularities using autologous fat transfer (AFT) toward reconstructing full breasts. Although many studies have researched the volumetric aspects of AFT, some outcomes such as volume retention and viability, as well as possible confounders for graft survival, remain unclear. This study aimed to answer these questions. MethodsPost-mastectomy women of the multicenter prospective BREAST-trial were randomized to either AFT breast reconstruction or implant-based reconstruction (IBR). Volumes were assessed using the Vectra 3D imaging system and compared at 12 months postoperative. Volume retention was defined as the augmented volume divided by the lipofilling volume. Significant confounders for graft survival were identified using multivariable regression analysis. ResultsA total of 148 patients (75 AFT, 73 IBR) were included in the final analyses. Postoperative volumes differed significantly at 12 months in favor of the IBR group (83.8ml, p<0.001). For AFT patients, graft survival did not decrease between 6 and 12 months, with a mean graft survival of 37.1% at 12 months. Significant confounders for graft survival included chest circumference (β=1.107, p=0.001), comorbidities (β =28.567, p=0.002), age (β =-0.514, p=0.007) and total lipofilling (β =-0.028, p<0.001). ConclusionPlastic surgeons can reconstruct voluminous breasts post-mastectomy using only AFT, these breast volumes stabilize at six months and VECTRA 3D is reliable for breast volume measurement. About a third of the grafted fat was calculated to survive postoperative and reconstructive surgeons should be aware not to transfer too much fat in one session.

Algorithm postmastectomy breast reconstruction secondary to breast cancer in a reference center in Mexico City

Background: Postmastectomy breast reconstruction represents a challenge for the plastic surgeon. Contemporary techniques offer numerous options, the reconstructive procedure performed depends on the individual profile of each patient, but will also be influenced by the surgeon's preoperative analysis of their individualized risk profile. Methods: Descriptive, longitudinal, and retrospective study. The reconstructed patients with breast cancer sequelae in the period from May 2023 to May 2024 were included. Based on the review of the literature and the experience of our center, a proposal for a breast reconstruction algorithm was formulated to standardize the ideal surgical treatment according to the case. Results: 119 patients were reconstructed using the algorithm to decide the ideal surgical management. Breast reconstruction was performed in 3 stages: the first stage [1st BRS] (119 patients) consisted of a tissue expander, breast implant ± acellular dermal matrix or autologous pedicled flaps after the mastectomy; in the 2nd BRS (68 patients) the expander was replaced with an implant with or without contralateral symmetrization; and finally in the 3rd BRS (18 patients), the reconstruction of the nipple-areola complex ± neurotization, autologous fat transfer and scar remodeling was performed. Conclusions: The algorithm proposed in this paper provides a guide for making decisions about ideal surgical management according to the clinical characteristics of each subgroup of patients to be reconstructed, improving results by making them reliable and predictable, which positively impacts patient's quality of life.

Advantages and Disadvantages of Breast Augmentation: Surgical Techniques, Outcomes and Future Directions.

Breast augmentation remains a highly sought-after cosmetic surgery, with various techniques available to enhance breast size using implants or fat transfer. This systematic review, spanning studies from 2003 to 2024 and adhering to PRISMA guidelines, evaluates the outcomes of different surgical approaches concerning scar quality, postoperative pain, patient satisfaction, and complications. The periareolar technique emerges as a favorable option, offering minimal postoperative pain, high patient satisfaction, and precise surgical control with subtle scarring. Transumbilical breast augmentation (TUBA) is noted for its scar-free approach, resulting in low pain and high satisfaction, though it requires specialized training and cannot use prefilled implants. The review highlights the varying complication rates across techniques: modern silicone implants, while safer than earlier injectable materials, still face risks such as rupture and capsular contracture. Autologous fat grafting is generally safer but can lead to issues like erythema and abscesses. The use of effective acellular dermal matrix (ADM) is linked to higher rates of seroma and infection compared to non-ADM procedures, although sterile human ADM shows a lower risk profile. The study underscores the importance of personalized surgical planning to optimize outcomes, as each technique offers distinct benefits and challenges. The findings suggest that future research should aim to refine these techniques and address their associated complications to further enhance patient satisfaction and surgical outcomes in breast augmentation.

Comparison of Outcomes after Autologous Breast Reconstruction: Latissimus Dorsi with Immediate Fat Transfer versus Abdominally Based Free Flaps.

Autologous breast reconstruction confers favorable patient reports of satisfaction and quality of life compared with implant-based reconstruction over a lifetime. The latissimus dorsi with immediate fat transfer (LIFT) is an alternative approach to abdominally based free flaps (Ab-FF), which expands fully autologous reconstruction to nonmicrosurgeons. This study compared the 2 procedures concerning their clinical and patient-reported outcomes 1 year postoperatively. The authors conducted a retrospective review of LIFTs and Ab-FFs performed between March of 2017 and August of 2022. The primary outcomes were postoperative complications, reoperations, and longitudinal BREAST-Q scores. BREAST-Q modules included Satisfaction with Breasts, Satisfaction with Abdomen, Satisfaction with Back, Psychosocial Well-being, Physical Well-being: Chest, Physical Well-being: Abdomen, Physical Well-being: Back, and Sexual Well-being. Of the 281 included patients (408 breasts), 211 received Ab-FF and 70 received LIFT. One-year follow-up (median [interquartile range], 12 [12] months) demonstrated that Ab-FF independently predicted dehiscence, reoperation procedures, and revisional surgery. LIFT independently increased the odds of seroma. Obesity predicted dehiscence, and bilateral reconstructions predicted revisional fat grafting. BREAST-Q scores fluctuated over time but were similar across all measured domains by 1 year postoperatively. Although Ab-FF is the standard approach for fully autologous reconstruction, LIFT procedures may be associated with a less complicated postoperative course while eliciting similar patient-reported outcomes. LIFT may be preferred to limit postoperative complications, particularly in patients with obesity. LIFT can be used by plastic surgeons who are not trained in microsurgical procedures or do not have an environment that fosters Ab-FF. Therapeutic, III.

Total autologous breast reconstruction: A combined approach with kiss LD flap and immediate fat transfer

Total autologous breast reconstruction: A combined approach with kiss LD flap and immediate fat transfer

The Role of Matrix Stiffness And Viscosity on Lipid Phenotype And Fat Lineage Potential.

Autologous fat transfer is a common procedure that patients undergo to rejuvenate large soft tissue defects. However, these surgeries are complicated by limited tissue sources, donor-site morbidity, and necrosis. While the biofabrication of fat tissue can serve as a clinical option for reconstructive surgery, the influence of matrix mechanics, specifically stiffness and viscosity, on adipogenesis requires further elucidation. Additionally, the effects of these mechanical parameters on metabolic and thermogenic fat potential haveyet to be investigated. In this study, gelatinmethacryloyl (GelMA) polymers with varying degrees of methacrylation (DoM) were fabricated to create matrices with different stiffnesses and viscosities. Human adipose-derived mesenchymal stem cells were then encapsulated in mechanically tunable GelMA and underwent adipogenesis to investigate the effects of matrix mechanics on lipid phenotype and fat potential. Mechanical testing confirmed that GelMA stiffness was regulated by DoM and weight composition, whereas viscosity was determined by the latter. Further work revealed that while lipid phenotype became more enriched as matrix stiffness and viscosity declined, the potential toward metabolic and thermogenic fat appeared to be more viscous dependent rather than stiffness dependent. In addition, fatty acid binding protein 4 and uncoupling protein 1 gene expression exhibited viscous-dependent behavior despite comparable levels of peroxisome proliferator-activated receptor gamma. However, despite the superior role of viscosity, lipid quantity and mitochondrial abundance demonstrated stiffness-dependent behavior. Overall, this work revealed that matrix viscosity played a more superior role than stiffness in driving adipogenesis and distinguishing between metabolic and thermogenic fat potential. Ultimately, this differentiation in fat production is important for engineering ideal adipose tissue for large soft tissue defects.

Strategy of Out-Fold Double Eyelid Corrected Into In-Fold: Low Position Design, Direction Control Suture, and Fat Transfer.

Double eyelid surgery is a common but delicate cosmetic procedure in Asia. Because of the precise requirements and technical reasons, patients who received blepharoplasty may not satisfied with their out-fold crease. Some patients are born with unsatisfied out-fold double eyelids. The medial creases of double eyelid were higher than should be. In this study, the authors developed a strategy to correct out-fold crease of double eyelid to in-fold to satisfy patients' requirements. From January 2022 to May 2024, 102 patients (96 females and 6 males) were included in this retrospective analysis. Patients with out-fold double-eyelid inborn or obtained. The patients were divided into 3 groups: inborn out-fold double-eyelid, obtained double-eyelid with epicanthus, and obtained double-eyelid without epicanthus. The surgical strategy contained low position design, direction control suture, and fat transfer. Preoperative and postoperative images were collected, and patients' satisfaction and complications were evaluated. In total, 102 consecutive patients were included in this study, with an average follow-up of 11.9 months. Eleven patients had inborn out-fold creases, and 83 patients had out-fold creases with epicanthus after primitive blepharoplasty, and 8 patients had out-fold creases without epicanthus after primitive blepharoplasty. Ninety-six (94.12%) patients were satisfied with their results. Complications included narrow double eyelid width (n =1, 0.98%), asymmetric creases (n=2, 1.96%), incompletely in-fold creases (n=3, 2.94%), and subtle fork in medial creases (n=4, 3.92%). The surgical strategy, which contained low-position design, direction control suture, and fat transfer, could correct out-fold creases of double-eyelid into in-fold effectively.

Differential Secretomes of Processed Adipose Grafts, the Stromal Vascular Fraction, and Adipose-Derived Stem Cells.

There are multiple methods to prepare lipoaspirate for autologous fat transfer; however, graft retention remains unpredictable. The purpose of this study was to compare the cellular and protein composition of adipose grafts and the stromal vascular fraction (SVF) resulting from three common techniques to prepare adipose grafts. Adipose grafts were harvested from healthy donors and processed via three techniques: centrifugation (C), a single-filter (SF) device, and a double-filtration (DF) system. Part of each graft was analyzed or further processed to isolate the SVF. Cell viability, surface markers, cytokine, and growth factors were compared between the graft and SVF as well as adipose-derived stem cells (ASCs). Overall, we found variations across the three processing techniques and among the graft components (ASCs, SVF, and fat). Cell viability within the grafts was similar (94.6%, 92.3%, and 93.6%; P = 0.93). The trend was a greater percentage of ASCs from SF versus DF or centrifugation (6.95%, 4.63%, and 1.93%, respectively, P = 0.06). Adipogenic markers (adiponectin and leptin) were similar among all three grafts (P = 0.45). Markers of tissue remodeling were greatest in the SVF compared with fat and ASCs, regardless of processing technique. There was higher relative expression of MMP-9 (2×), Extracellular matrix metalloproteinase inducer (EMMPRIN) (2.5×), endoglin (5×), and IL-8 (1.5×) in the SVF (P < 0.005). Our study identified differences in cytokine expression in adipose grafts and the SVF, particularly in cytokines important in inflammation and wound healing. These secretomes may impact graft retention and fat necrosis and have the potential implications in cell-assisted lipotransfer. There were no significant differences between the final products of any of the processing techniques.

External and internal oblique muscle amplification by Semilunaris PArallel to Rectus fat Transfer (SPARTAN)

External and internal oblique muscle amplification by Semilunaris PArallel to Rectus fat Transfer (SPARTAN)

Pterostilbene, a Resveratrol Derivative, Improves Ovary Function by Upregulating Antioxidant Defenses in the Aging Chickens via Increased SIRT1/Nrf2 Expression.

Oxidative stress is recognized as a prominent factor contributing to follicular atresia and ovarian aging, which leads to decreased laying performance in hens. Reducing oxidative stress can improve ovarian function and prolong the laying period in poultry. This study investigates the impact of Pterostilbene (PTS), a natural antioxidant, on ovarian oxidative stress in low-laying chickens. Thirty-six Hy-Line White laying chickens were evenly divided into four groups and fed diets containing varying doses of PTS for 15 consecutive days. The results showed that dietary supplementation with PTS significantly increased the laying rate, with the most effective group exhibiting a remarkable 42.7% increase. Furthermore, PTS significantly enhanced the antioxidant capacity of aging laying hens, as evidenced by increased levels of glutathione, glutathione peroxidase, superoxide dismutase, catalase, and total antioxidant capacity in the ovaries, livers, and serum. Subsequent experiments revealed decreased expressions of Bax, Caspase-3, and γ-H2AX, along with an increased expression of BCL-2 in the ovaries and livers of laying hens. PTS supplementation also positively affects fat metabolism by reducing abdominal fat accumulation and promoting fat transfer from the liver to the ovary. To elucidate the mechanism underlying the effects of PTS on ovarian function, a series of in vitro experiments were conducted. These in vitro experiments revealed that PTS pretreatment restored the antioxidant capacity of D-galactose-induced small white follicles by upregulating SIRT1/Nrf2 expression. This protective effect was inhibited by EX-527, a specific inhibitor of SIRT1. These findings suggest that the natural antioxidant PTS has the potential to regulate cell apoptosis and fat metabolism in laying chickens by ameliorating oxidative stress, thereby enhancing laying performance.

13. Combination of Denervation with Autologous Fat Transfer (CoDRAFT): A Novel Technique and Outcomes in the Treatment of Thumb Carpometacarpal Arthritis

13. Combination of Denervation with Autologous Fat Transfer (CoDRAFT): A Novel Technique and Outcomes in the Treatment of Thumb Carpometacarpal Arthritis

The efficacy of prolonged antibiotic prophylaxis in total breast reconstruction with Autologous Fat Transfer (AFT): A retrospective cohort study

BackgroundAutologous fat transfer (AFT) is increasingly adopted as another total breast reconstruction option. The aim of this study is to investigate the efficacy of prolonged antibiotic treatment on the onset of surgical site infections in patients treated with AFT for total breast reconstruction. MethodsThis retrospective cohort study was conducted on patients who received AFT for total breast reconstruction, with antibiotic prophylaxis during their (multiple) AFT procedure(s) from 9 December 2020 to 10 October 2023. Patients were divided into two groups according to their prophylactic antibiotic regimen. The primary outcome was analysed as the cumulative incidence, the relative risk (RR), the absolute risk reduction (ARR), and the number needed to treat (NNT). For the secondary outcome, a multilevel logistic regression analysis was performed. Results765 surgeries in 205 patients were analyzed. 624 surgeries on 168 patients had perioperative antibiotic prophylaxis in combination with post-operative antibiotic prophylaxis was administered (group 1). 141 surgeries on 37 patients had only perioperative antibiotic prophylaxis administered (group 2). The RR was 0.68 (95%CI 0.14 – 3.31) of a surgical site infection (SSI) when receiving peri- and postoperative antibiotic prophylaxis in comparison to treatment with only perioperative prophylaxis. The ARR was 0.46% (95%CI -1.40 – 2.32) with a NNT of 219 patients. ConclusionProlonged antibiotic prophylaxis is ineffective for patients who receive total breast reconstruction with AFT. This study showed no statistically significant difference in SSIs of the reconstructed breast after receiving prolonged antibiotic treatment in comparison to single shot peri-operative antibiotic prophylaxis.

The Learning Curve of Total Breast Reconstruction With Autologous Fat Transfer.

Total breast reconstruction with autologous fat transfer (AFT) is a relatively new breast reconstruction method. Although AFT was predominantly used to correct postsurgical defects, the surgical skills of a total breast reconstruction with AFT are different and can be facilitated for novices to accelerate their learning process. This study aims to assess the learning curve of plastic surgeons in total breast reconstruction with AFT in the Netherlands. A mixed-methods study was performed based on the multicenter randomized clinical BREAST trial data. For the qualitative analysis, semistructured interviews were conducted. To test hypotheses derived from the qualitative data, retrospective data analysis was performed using multilevel linear regression analysis of the patients undergoing AFT as a total breast reconstruction method. The interviews revealed that plastic surgeons need to perform the procedure several times to learn and experience the technical details of total breast reconstruction with AFT. Learning and improving this technique works best by scrubbing in with an expert. Before plastic surgeons learn the optimal volume of fat reinjection over time, they tend to inject too little fat and subsequently too much fat over multiple procedures. With more experience, the rigottomy technique becomes more important. Besides technical details, managing patient expectations before starting treatment is paramount. Multilevel linear regression revealed a significant decrease ( P < 0.001) in the number of surgical procedures and the total injected volume ( P = 0.002) to complete a total breast reconstruction with AFT. This is the first study that explores the learning curve involved in using AFT as a total breast reconstruction method. The feeling of when fat transfer is sufficient, and how to release scars for a good result without causing seromas, is best learned by scrubbing in with experienced colleagues during several procedures, interchanged with starting one's own practice.

Effectiveness of Autologous Fat Grafting in the Treatment of Scars: A Systematic Review and Meta-Analysis.

Autologous fat transfer (AFT) has been proposed as a possible treatment for scar tissue and its associated symptoms. Its effectiveness's evidence is yet unidentified though. The aim of this meta-analysis is to evaluate the currently available evidence on the efficacy and safety of autologous fat transfer in treating post-burn and post-traumatic scars using a validated scar measurement tool. This study performed a systematic literature review in November 2023 using the following electronic databases: MEDLINE, SCOPUS, Directory of Open Access Journals (DOAJ), PUBMED, and Google Scholar. The following key terms were included: (Fat grafting OR Autologous fat transfer) AND (body scars OR body burns OR body wounds) AND (Efficacy OR Safety OR satisfaction). We evaluated articles according to predefined quality criteria. The following data wereincluded during the extraction period: patient demographics, indications for AFT, the number of AFT sessions, follow-up periods, and changes in the Patient and Observer Scar Assessment Scale (POSAS) scores, which contain both the patient and observer components. This study included 1326 patients and 23 published articles. A total of 14 prospective studies, 7 retrospective studies, and 2 Randomized clinical trials studies were evaluated. These 23 articles came from diverse global locations; the earliest was published in 1992, and the most recently published in 2022. Our findings demonstrated significant enhancements in scar characteristics from both patient and observer perspectives. Overall, AFT holds promise as a valuable treatment option for scar-related conditions as it enhances scar quality ,contributing to improved patient outcomes and satisfaction. 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.

68 The Emerging Role of Stem Cell Enriched Fat Grafts for Breast Reconstruction: A Systematic Review and Meta-Analysis

Abstract Aim Recent trials involving adipose derived stem cell (ADSC) enriched fat grafts have shown promising results when compared to routine autologous fat transfer (AFT) in breast reconstruction surgeries. The current systematic review and meta-analysis aimed to compare outcomes of ADSC-enriched fat grafts versus routine AFT for breast reconstruction purposes. Method A search of electronic information was conducted identifying all case control and cohort studies comparing the outcomes of ADSC-enriched fat grafts versus routine AFT for breast reconstruction. Primary outcomes included volume retention, fat necrosis and cancer recurrence. Secondary outcome measures were patient satisfaction post-surgery, cyst development, redness and swelling, infection and operation time. Fixed and random effects modelling were used for the analysis. Six studies enrolling 381 subjects were selected. Results There was a significant difference between the ADSC-enriched fat grafts and routine AFT groups in terms of mean volume retention (standardised mean difference [MD]= 2.52, P= 0.05). There were no significant differences between the two groups in terms of fat necrosis (Odds Ratio [OR]= 3.81, P =0.13) and cancer recurrence (OR= 1.39, P= 0.58). For secondary outcomes, the intervention group had similar results compared with the control group in terms of patient satisfaction, redness and swelling as well as infection and cyst development. Operation time was shorter for the latter group. Conclusions ADSC-enriched fat grafting is a superior option compared to the routine AFT for breast reconstruction surgery as it improves the mean volume retention and does not worsen patient satisfaction and surgical complications.

Attenuated angiogenesis and macrophage infiltration during adipose tissue regeneration in a megavolume human fat grafting nude mouse model.

Survival and regeneration mechanisms of large (>250 mL) fat grafts remain incompletely understood. In fat grafts from volunteers with megavolume fat transfer breast augmentation, neovascularization and inflammatory cell infiltration decreased within 7 days according to histological analysis. We further investigated this phenomenon using a nude mouse model. To simulate clinical contexts, chambers containing 1 mL human fat were implanted into nude mice. Chambers allowed selective transfer of tissue fluid from recipient nude mice into chambers, but not capillaries or macrophages. Seven days later, fat was removed from the chamber and reimplanted into a new nude mouse in the open-chambered fat group (OCFG, n=45). Adipose samples from volunteers and explanted grafts from OCFG were subjected to histological analyses. Graft weight, vascularization, and immune response were also compared between the OCFG and conventional direct fat grafting (control group (CG)). Percent tissue integrity, percent fibrosis, adipocyte viability, and neovascularization did not significantly differ between volunteer samples and OCFG grafts at day 7. On day 90, OCFG retention rate was decreased relative to CG and the fibrosis area was larger in the OCFG than in the CG. However, the macrophage and capillary counts were lower in the OCFG group relative to CG at days 7 and 14 after transplantation. The present study provides histological analyses of megavolume fat grafts sampled from clinical breast augmentation tissues and a xenograft nude mouse model. However, these preliminary results in a small clinical cohort should be further assessed in large allogeneic animal models.