Fat Transfer Research Articles

Decoding the Implications of Glucagon-like Peptide-1 Receptor Agonists on Accelerated Facial and Skin Aging.

Following the advent of glucagon-like peptide-1 receptor agonists (GLP1RA), subsequent unintended effects such as accelerated facial aging and altered skin health have been noted. This review delves deeper into the causative underlying mechanisms and provides insights into the intricate relationship between GLP-1RA, adipose tissue, and premature facial aging, thereby highlighting the need for a nuanced understanding of their effects on facial alterations and skin health. Studies exploring the potential effects of GLP-1RA on facial alterations and offering insights into the possible underlying mechanisms, causes and clinical implications were included. The accelerated facial aging and altered skin health observed in GLP-1RA patients appears to be multifactorial, involving loss of dermal and subcutaneous white adipose tissue, altered proliferation and differentiation of adipose-derived stem cells (ADSCs), and impacts on the production and secretion of hormonal and metabolic factors. These changes compromise the structural integrity and barrier function of the skin and may lead to diminished facial muscle mass, further exacerbating the appearance of aging. The insights presented call for a paradigm shift in the clinical management of facial changes induced by GLP-1RA, with a focus on treatment strategies aimed at targeting ADSC stimulation. These include autologous fat transfers to reintroduce cells rich in ADSCs for rejuvenation, composite fat grafting combining autologous fat with/without stromal vascular fraction, and the strategic use of soft tissue fillers for volume restoration and biostimulation. This review highlights the potential role of GLP-1RA in modulating adipose tissue dynamics, contributing to accelerated aging through metabolic, structural, and hormonal pathways.

Patients Requiring Multiple Surgeries for Velopharyngeal Insufficiency: Findings From a 10-Year Retrospective Review.

This study analyzed patients undergoing multiple surgeries for velopharyngeal insufficiency (VPI) and reviewed their preoperative evaluations and techniques selected for subsequent surgeries. A retrospective chart review was performed including patients having undergone multiple surgeries for VPI at the authors' institution between 2012 and 2022. All patients were evaluated and managed at the author's institution under the direction of 4 senior surgeons. The objective of this study was to provide insight into preoperative evaluation, surgical technique selection, and other factors that may contribute to patients who require multiple VPI surgeries. Of 71 patients having undergone surgery for VPI, 8 required at least 1 additional operation for persistent VPI following the initial intervention. Six patients who initially underwent a superiorly based posterior pharyngeal flap (PPF) required additional surgery, and for those patients' subsequent operations, 5 different techniques were used throughout their treatment. Of the remaining 2 patients who had multiple VPI surgeries, 1 initially received autologous fat transfer and 1 initially underwent a furlow palatoplasty. Finally, 0 patients that initially underwent buccal flaps or collagen injection required further unplanned surgical intervention. This study demonstrates the importance of selecting an appropriate surgical approach when operating on patients following a failed VPI surgery. The algorithm developed from these findings emphasizes the importance of properly identifying the anatomical deficiency resulting from the failed intervention. A review of the advantages of nasopharyngoscopy as a preoperative evaluative technique of velopharyngeal form and function when compared to lateral barium video fluoroscopy was also included.

Comparison of Fat Transfer Combined with Plasma Energy and Only Fat Transfer Methods for Genital Rejuvenation.

To compare the fat transfer combined with plasma energy and only fat transfer methods for genital rejuvenation and to investigate the efficacy enhancing properties of plasma energy. Forty-six patients were equally divided into two groups according to the surgical method as the group A (n = 23) and the group B (n = 23). The patients in the group A received only fat transfer, while the patients in the group B received fat transfer combined with plasma energy. Both groups were scheduled for postoperative follow-up at 1, 3, 6, and 12 months. The lifting effect on the labia majora after the procedure was evaluated with photographs and patient satisfaction questionnaires including the female genital self-image scale (FGSIS). The mean age of all participants was 32.8 ± 5.1 years, and the mean body mass index (BMI) was 24.7 ± 3.4kg/m2. The mean preoperative FGSIS scores were similar between the groups (p = 0.542). The mean total FGSIS score was 18.8 ± 1.4 in the group A and 18.3 ± 1.5 in the group B in the preoperative period. However, the mean FGSIS scores at 1, 3, and 6 months were significantly higher in the group B than the group A (p = 0.032, p = 0.012, and p = 0.009, respectively). At 6 months of follow-up, the mean total FGSIS score was 20.7 ± 1.4 in the group A and 22.3 ± 1.5 in the group B, indicating a statistically significant difference (p = 0.028). This novel technique is a more minimally invasive technique compared to other energy modalities with lower lateral and vertical energy dissipation than other conventional methods, and labia majora fat filling augmentation application can be performed with more permanent and longer-lasting outcomes than fat transfer only. 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.

Black women, Brazilian butt lifts and body image: A qualitative study on the role social media play in promoting the thick ideal

Black women, Brazilian butt lifts and body image: A qualitative study on the role social media play in promoting the thick ideal

Autologous Fat Grafting Air-valve Loading Technique.

Autologous fat transfer is fast becoming a common adjunct procedure in plastic surgical operations, especially in breast reconstruction. Postharvest fat processing can be performed actively or passively with various techniques. All techniques require the final step of loading the harvested fat into a syringe for injection. We describe here an innovative and elegant technique for safer and more efficient loading of the plunger back into the barrel of a fat-filled syringe before injection. This technique improves ease of loading, reduces loss of harvested fat, and eliminates the risk of bodily fluid splash.

Characterization of Fat Used for the Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty.

Septorhinoplasty (SRP) is one of the most common aesthetic procedures worldwide. A thin or scarred soft tissue envelope, especially in the context of secondary SRP, can lead to unpredictable scarring, shrinkage, and discoloration of the skin. Other than the careful preparation of the soft tissue mantle, no gold standard exists to minimize the above-mentioned risks. Our aim was to create a thin "separation layer" between the nasal bridge (osseous and cartilaginous) and the skin envelope by autologous fat transfer with the addition of platelet-rich fibrin (PRF) to conceal small irregularities, to improve the quality of the skin soft tissue mantle, and to optimize the mobility of the skin. We report 21 patients who underwent SRP on a voluntary basis. All patients had either thin skin and/or revision SRP with scarring. Macroscopic fat harvested from the periumbilical or rib region was minced and purified. PRF was obtained by centrifugation of autologous whole blood samples and mixed with the fat to form a graft, which was then transferred to the nasal dorsum. Postoperative monitoring of graft survival included sonography and magnetic resonance imaging (MRI) of the nose. The harvested adipose tissue was also analyzed in vitro. In the postoperative follow-up after 1 year, survival of the adipose tissue was demonstrated in all patients by both sonography and MRI. The in vitro analysis showed interindividual differences in the quantity, size, and quality of the transplanted adipocytes. Camouflage of the nasal bridge by using adipose tissue was beneficial for the quality of the skin soft tissue mantle and hence represents a good alternative to known methods. Future aims include the ability to assess the quality of adipose tissue to be transplanted based on clinical parameters. Level of evidence: N/A.

Exploring Anti-Fibrotic Effects of Adipose-Derived Stem Cells: Transcriptome Analysis upon Fibrotic, Inflammatory, and Hypoxic Conditioning.

Autologous fat transfers show promise in treating fibrotic skin diseases, reversing scarring and stiffness, and improving quality of life. Adipose-derived stem cells (ADSCs) within these grafts are believed to be crucial for this effect, particularly their secreted factors, though the specific mechanisms remain unclear. This study investigates transcriptomic changes in ADSCs after in vitro fibrotic, inflammatory, and hypoxic conditioning. High-throughput gene expression assays were conducted on ADSCs exposed to IL1-β, TGF-β1, and hypoxia and in media with fetal bovine serum (FBS). Flow cytometry characterized the ADSCs. RNA-Seq analysis revealed distinct gene expression patterns between the conditions. FBS upregulated pathways were related to the cell cycle, replication, wound healing, and ossification. IL1-β induced immunomodulatory pathways, including granulocyte chemotaxis and cytokine production. TGF-β1 treatment upregulated wound healing and muscle tissue development pathways. Hypoxia led to the downregulation of mitochondria and cellular activity.

Abdominal Etching with Renuvion Helium Plasma

Abstract Goals/Purpose Differential liposuction with abdominal etching is a powerful technique in high definition liposculpture to achieve an athletic aesthetic. Etching is performed in a superficial plane to create indentures mirroring the dermal-fascial inscriptions of the underlying desired musculature. Renuvion radiofrequency-helium plasma energy (Apyx Medical, Clearwater, FL) is an emerging technology that is used for subdermal coagulation and contraction of the subcutaneous tissue. This case series describes combination of differential liposuction with abdominal etching and Renuvion helium plasma subdermal coagulation in 68 patients and evaluates the outcomes. Methods/Technique A retrospective chart review of 68 patients undergoing differential liposuction with abdominal etching and Renuvion helium plasma subdermal coagulation between 2021 to 2023 by the senior author. The preoperative evaluation, markings, surgical technique and postoperative care are discussed. Clinical parameters assessed include age, gender, body mass index, combination of procedures, volume of lipoaspirate, degree of etching (light, moderate, deep), postoperative changes in weight, and complications such as contour irregularity, wound dehiscence, seroma, surgical site infection, patient dissatisfaction and operative revision. Results/Complications 68 consecutive patients who underwent abdominal etching with Renuvion by the senior author between July 2021 and August 2023 were included in this case series. There were 29 males (43%) and 39 females (57%). The average age of the patients was 39.11 (range, 22 to 64 years), with a non obese, average body mass index of 27.65 kg/m2 (range, 20.8 to 33.9 kg/m2). The average estimated intraoperative blood loss of patients was 104.68 ml (range, 75 to 150 ml); with an average tumescence of 4600 ml (range, 1400 to 8000 ml). The average lipoaspirate was 3920 ml (range, 500 to 9000 ml). In addition to the abdominal region, other areas liposuctioned at the time of etching included flanks (68, 100%), back (66, 97.05%), thighs (14, 20.58%), arms (9, 13.23%), neck (9, 13.23%), chest (8, 11.76%), axilla (3, 4.41%), calves (1, 1.47%). Use of ultrasound was used in 6 cases (8.82%), which were revisionary liposuction. Of our 68 abdominal etching with Renuvion cases the most common combined procedure was autologous fat transfer (20, 29.41%), platysmaplasty (4, 5.88%), mastopexy (5, 8%), breast augmentation (4, 5.88%), buccal fat pad excision (3, 4.41%), umbilical hernia repair (1, 1.47%) and rhytidectomy (1, 1.47%). There were 5 cases of seroma (7.35%) and 4 cases of contour irregularity (5.88%). There were 3 cases of surgical site infection (4.41%), but all in the area of fat grafting and not in the area of liposculpture. No cases of hyperpigmentation were identified. No major complications occurred including skin burns, skin necrosis, visceral injury, deep vein thrombosis, or pulmonary embolism. Overall 66 patients (97.05%) were satisfied following their procedure. Operative revision occurred in two patients (2.94%), who had residual skin laxity following Renuvion and desired skin excision. Conclusion Differential liposuction with abdominal etching and Renuvion helium plasma are safe and effective in combination to synergistically achieve an athletic physique and enhance abdominal aesthetics. Complication rates are low with appropriate surgical technique. Almost all patients reviewed were satisfied with the procedure and maintained long-term results.

Brazilian Butt Lift: An Experience Over 3000 Patients.

The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer. Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure. Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures. BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. LEVEL OF EVIDENCE 3: 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 .

Breast fat grafting and cancer: a systematic review of the science behind enhancements and concerns.

Autologous fat transfer (AFT) is gaining popularity in breast surgery, offering a natural-looking and minimally invasive approach for augmentation, reconstruction, and contouring. However, concerns about its impact on breast cancer necessitate an understanding of the interplay between transplanted adipose-derived stem cells (ADSCs) and the breast tissue microenvironment. Renowned for regeneration, ADSCs raise questions about their role in cancer promotion. This systematic review delves into the complex relationship between AFT and breast cancer, exploring how ADSCs may influence development, growth, and metastasis. A systematic search of electronic databases, including PubMed, Embase, and BVS was conducted to identify relevant studies. The search strategy employed a combination of keywords, including "breast augmentation", "fat grafting", "breast enhancement", "mammoplasty", "cancer", "neoplasm" and related terms. Two reviewers independently screened titles and abstracts. Full-text articles were then retrieved for further evaluation based on their potential contribution to the review objectives. Two hundred and forty records were identified. Among these, 104 duplicates were removed, resulting in 136 reports available for title and abstract screening. Subsequently, 54 papers were deemed potentially eligible for inclusion, and all reports were retrieved. In vitro studies reveal ADSCs dual role in breast cancer, influencing proliferation, migration, and drug resistance through complex signaling pathways. Animal studies highlight distinct ADSC subpopulations impacting tumor growth via direct interactions and extracellular vesicle cargo. In vivo, ADSC-enriched fat grafting is generally safe, showing no increased cancer recurrence risk compared to other methods. Notably, cases of invasive breast carcinoma warrant special attention. ADSC-enriched fat grafts exhibit potential benefits in graft retention and survival rates. Despite promising evidence, further studies are needed to comprehensively understand the intricate relationship between ADSCs and breast cancer for optimized clinical applications and potential therapeutic innovations.

O166: Safety and Efficacy of Autologous Fat Grafting in the Treatment of Radiation-Induced Fibrosis and Contour Defects in Head and Neck Reconstruction

Abstract Background Multimodal treatment for head and neck cancer results in significant functional and cosmetic morbidity, often through contour deformity and radiation-induced skin fibrosis (RIF), affecting head and neck function and cosmesis. Autologous fat grafting is an emerging treatment for RIF. We conducted a retrospective cohort review of patient outcomes following autologous fat transfer for reconstruction of head and neck contour deformity and RIF. Methods A retrospective analysis was performed of patients treated at 2 UK centres between 2009-2022. Patient data collated included demographics, oncological treatment, reconstruction, operative details, and pre- and post-operative patient reported outcome measures (PROMs) including University of Washington Quality of Life Questionnaire (UW-QOL), Derriford Appearance Scale (DAS24) and Patient Outcomes of Surgery (POS). Patients were stratified by indication for AFG. Results A total of 45 patients were identified. 89% of patients (85% RIF, 92% contour deformity) reported cosmetic or functional improvement. Two patients (4%) reported no improvement, and three (7%) were lost to follow-up. Psychological health scores improved in patients following AFG for both RIF and contour deformity patients (DAS24, P< 0.0001). The UW-QOL scores revealed statistically significant improvements in multiple functional domains including appearance, activity, recreation, mood, and anxiety in both patients with RIF and contour deformities. Conclusion This study demonstrates that AFG is an effective technique for the correction of contour deformity and RIF in patients following treatment for head and neck cancer. Patients suffering from RIF demonstrated significant improvements in both functional and psychological domains.

O244: Patients’ priorities in Vulval lichen sclerosus – results of a patient and public involvement for a study investigating autologous lipotransfer and platelet-rich plasma in Vulval lichen sclerosus

Abstract Background Vulval lichen sclerosus (VLS) is a high-burden, under-researched chronic skin disease. It is characterised by itching, pain, sexual dysfunction and poor quality of life. Up to 70% of patients develop fibrosis and vulval architectural changes. The only evidence-based treatment includes topical steroids. New potential surgical treatments include autologous fat transfer (AFG) and platelet-rich plasma (PRP) injections but high-level evidence supporting these treatments is sparse. Aims To identify patients’ research priorities and evaluate the acceptability of AFG and PRP as treatments for VLS and design a trial co-produced by patients. Methods One-to-one interviews, focus groups and online questionnaires were used to investigate patients’ research priorities, acceptability of treatments, preferred outcome assessment tools, views on a sham procedure and trial design. Results A focus group (n=18) and an online patient survey (n=809) identified the top research priorities: changes to vulval anatomy, emotional impact on intimate relationships, inability to have penetrative intercourse and pain during intercourse. Patients reported poor quality of life and said that addressing these would be life-changing. Ninety-nine percent of patients agreed that this trial should be performed and 73% were willing to take part if a sham procedure was used. A patient advisory group (n=5) has been created to co-produce the trial. Conclusion VLS is a complex disease with no core outcome set. Patient co-production is a keystone to a successful trial design and ensures that research is aligned with patients’ priorities. This research defines the key priorities of research into current surgical interventions for VLS.

Autologous Fat Transfer in Craniofacial Surgery

Over the past two decades, autologous fat transfer has garnered significant recognition and widespread adoption within esthetic and reconstructive surgical domains. In craniofacial surgery, fat transplantation is frequently employed to address soft tissue volumetric deficiencies and asymmetries that influence facial contours. While adipose tissue (AT) is widely regarded as an optimal choice for augmentation due to its abundant availability and biocompatibility, the unpredictability and heightened resorption rates observed with traditional lipofilling techniques present a challenge for clinicians. Adipose-derived stem cells (ASCs) housed within the grafted tissue play a pivotal role in graft survival and offer avenues for tissue repair due to their angiogenic, anti-inflammatory, and immunosuppressive properties. Micro Fragmentation of Adipose Tissue (MFAT), utilized in several FDA-approved processing devices, has demonstrated promising outcomes in treating osteoarthritic joints, with success primarily attributed to enhanced paracrine function of ASCs via preservation of the perivascular niche. Currently, its application for treating bone or articular defects in the craniofacial region, including abnormalities of the temporomandibular joint, remains limited. This scarcity underscores the need for further investigation prior to its widespread integration into clinical practice.

Fat transfer principles and applications in plastic surgery: a literature review

Fat transfer of fat grafting is a renowned technique in plastic surgery, in which harvested fat tissue is injected beneath the skin into part of the body to be reconstructed. The fat transfer technique is the most popular choice for reconstructive and cosmetic procedures due to its low immunogenicity, low cost, and ease of access. In cosmetic, reconstructive plastic surgery, the fat transfer procedure is done by moving fat tissue from one body part to another body part. It consists of five main procedures: harvesting fat tissue, processing fat tissue, determining the recipient location, transferring or grafting fat tissue, and retaining or surviving the graft/fat transfer results. Procedures for fat transfer are typically done on the face, breasts, and buttocks. Fat transfer can lead to many consequences, such as skin issues, hematomas, infections, seromas, and even fatal fat emboli. This literature review aims to explain the principles of fat transfer and their applications in plastic surgery.

Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer

Background: The rejuvenation and restoration of a well-defined jawline contour are crucial for enhancing facial aesthetics in both men and women. Within the jawline aesthetic unit (mandibular angle), the masseter muscle plays a significant role, as it is responsible for mandibular masticatory movements. We propose a new approach using ultrasound-guided intramuscular fat transfer to enhance the mandibular angle and jawline. Methods: The multicenter study included 20 patients from three countries (Peru, Brazil, and Mexico). After fat harvesting, the ultrasound-guided masseteric fat transfer was performed with a 1.5-mm Viaro cannula from an incision beneath the ear lobule. The fat was then injected intramuscularly into the masseter at each side of the mandibular angle. Results: Masseter ultrasound-guided fat transfer was performed on 10 men and 10 women between 2021 and 2022. The patients had a mean age of 34.4 ± 6.39 years and a mean body mass index of 22.39 ± 2.59 kg per m2. The mean injected volume was 5.83 mL and 5.58 mL on the right and left sides, respectively. Muscle thickness increased in patients immediately postsurgery, but decreased after 1 month. The muscle remained significantly thicker on each side than the presurgery measurements in patients regardless of gender (both P < 0.0001). Conclusions: Ultrasound-guided intramuscular fat transfer is a safe and reproducible technique for enhancing the jawline contour at the mandibular angle. We believe that it could be a more durable solution than other procedures, although further evaluation of long-term results is necessary.

Oncologic safety of autologous fat grafting in primary breast reconstruction after mastectomy for cancer

IntroductionAutologous fat transfer (AFT) is widely used to improve results of breast reconstructive surgery, but its safety is controversial. Our objective was to evaluate the oncologic safety of AFT in a homogeneous population of patients who underwent a total mastectomy with immediate reconstruction for breast cancer. MethodsWe performed a retrospective cohort study by identifying all patients who underwent immediate breast reconstruction after mastectomy for breast cancer from 2007 to 2015 in our center. A patient group with AFT performed in the 24 months after mastectomy was compared to a control group. ResultsFive hundred fifty cases were included, of whom 136 (24.7%) underwent at least one fat graft transfer. Median age was 51 years. Reconstruction was performed in 465 (84.5%) with an implant reconstruction. The median time from mastectomy to AFT was 13.8 months. The median follow up was 55.2 months. A total of 53 events were observed, including 10 (7.4%) in the AFT group and 43 (10.4%) in the control group. There was no difference in 5-year recurrence-free survival (RFS) between the groups. In the subgroup analysis, only lymph node involvement in patients who underwent AFT in the first 24 months after oncologic surgery appeared as a risk factor of recurrence. Among the 104 patients with lymph node involvement, 5-year RFS was 69.2% in patients with lipofilling vs 92.5% in patients without it (p = 0 0.0351). ConclusionPerforming early lipofilling in primary breast reconstruction after mastectomy for cancer seems to be oncologically safe. Lymph node involvement increases the risk of recurrence in this population.

(229) A Pilot Study of a Novel PRP Protocol to Increase Penile Length, Girth, and Function

Abstract Introduction A study of a novel PRP protocol to increase penile length, girth, and function Intro: Various solutions have been utilized to increase penis size, including fillers, fat transfers, traction devices, suspensory ligament ligation, and silicon augmentation. None of these improve length, girth, function and are completely safe. PRP is an autologous source of growth factors. The RestoreX is a well-studied traction device. Vacuum erection devices provide a stimulus for circumferential penile growth. Nitric Oxide boosters improve blood flow and nighttime erections. Objective The P-Long Study aims to find a safe and reproducible way to increase the length, girth, and function of a normal male penis. Methods The study is IRB approved and patient consented. Inclusion criteria: healthy men aged 20 to 55 with normal erectile function (SHIM greater than 22) and no Peyronie’s Disease, previous penile interventions, or congenital penile issues. Measurement of penile length and girth were performed by the patient on an erect penis during self-stimulation at full tumescence with standard protocol and measuring instruments (transparent rigid ruler and flexible tape measure) and documented with digital images. No PDE-5 inhibitors or Trimix were used. Measurements were taken at baseline and once a month for six months. PRP was administered in the right and left corpora under ultrasound guidance once a month for six months using PureSpin double spin system (60cc blood drawn) Centrifuge technical data show an average platelet recovery of 84% and average concentration of 6.6 times that of the whole blood sample. Using this data, the injection of 10cc of PRP, assuming a starting platelet count of 250K/microliter, would contain approximately 1.65 billion platelets. Traction with RestoreX 20 minutes bid and suction with Joel Kaplan penis pump (pressure 5-10 for 12 minutes bid (1 minute x 2 and 5 minutes x 2.) Nitric Oxide boosting supplement (trade name AFFIRM) with a dose of 3 gm L-Citrulline and 1 gm beet extract (nitrate). Results 29 men have completed treatment. The mean age was 32 and mean baseline erect penile length was 5.70 and girth was 5.25. Erect penis length was 0.805 inch greater after six months from baseline (N=29, paired t-test t=13.641 p value=0.000). Circumference was 0.469 inch greater (N=29, paired t-test t=13.498 p value=0.000). Using a Likert scale, all participants reported better erectile function. Conclusions The P-Long Protocol is potentially a safe way to improve erect penile length 0.81 inches and girth 0.47 inches over a period of six months and subjectively improve function in a healthy penis. The P-Long Protocol does not require any synthetic injectables or foreign bodies or extensive penile traction. The P-Long Protocol ultrasound-guided PRP injection can be taught to urologists and sexual medicine practitioners. It does not preclude additional augmentation procedures and is potentially an acceptable first option for men interested in penile enhancement. This study provides a guide for expectations for growth for men using the protocol. The slope of the growth curve indicates possible continued growth with additional treatments. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science.

Temperance With Tranexamic Acid: Increased Risk of Venous Thromboembolism in Abdominoplasty.

Abstract Tranexamic acid (TXA) is used widely in surgery to mitigate blood loss by inhibiting the fibrinolytic degradation of clots. The occurrence of venous thromboembolism (VTE) with TXA has not been reported in the plastic surgery literature. In the realm of plastic surgery, abdominoplasty has the highest rate of VTE. The purpose of this study is to report 5 cases of VTE with TXA. A single surgeon reviewed the records of 5 patients who incurred VTE with TXA. TXA was added to the tumescent fluid, 20 mg/kg total. Four of the 5 patients underwent abdominoplasty combined with liposuction and breast surgery, and the fifth, fat transfer to the breast. The abdominoplasty patients had received chemoprophylaxis. Upon presentation of symptoms, the patients were sent to the hospital for anticoagulation and hematology consultation. The 5 patients survived their VTE events; 2 only required oral anticoagulation, 2 required IV heparin then oral, and 1 required tissue plasminogen activator (tPA) then oral. VTE with abdominoplasty occurred in 0 of 399 cases prior to the use of TXA and in 4 of 98 cases after the use of TXA in the tumescent. Although the occurrence of VTE with abdominoplasty increased with the use of TXA for the senior author, this retrospective case study does not prove a causal relationship between TXA and VTE. Level of Evidence: 4

The role of platelet rich plasma enriched fat graft for correction of deformities after conservative breast surgery.

Fat transfer has been widely used after breast conservative surgery (BCS) where it aims to recover shapes as a simple, inexpensive, biocompatible method but the technique is not without complications. Platelet Rich Plasma (PRP) is a promising approach to enhance fat graft survival and subsequently improve the outcome. The aim of this study was to evaluate the effect of enriching fat graft with PRP for delayed correction of deformities after conservative surgery for breast cancer regarding esthetic outcome and incidence of complications. The current study included 50 female patients who were scheduled for delayed lipofilling for correction of deformities after conservative surgery for breast cancer. The studied patients were randomly allocated into 2 groups: Group I (G I) included 25 patients scheduled for PRP enriched lipoinjection and Group II (G II) included 25 patients scheduled for lipoinjection without PRP as a control group. Number of sessions of lipoinjection was significantly less in G I in comparison to G II (P =0.024). During the 2nd session; the amounts of fat injected and harvested were significantly less in G I in comparison to G II (P =0.049 and 0.001 respectively). Recipient site complications were significantly more evident in G II in comparison to G I (P =0.01). Surgeon and patient satisfactions were significantly more evident in GI in comparison to G II (P =0.005 and 0.029 respectively). The addition of PRP to fat grafts is a simple, cost-effective and safe method to improve esthetic outcome and decrease complications.

Current trends in breast cancer surgery.

The incidence of breast cancer has been increasing significantly over the past decades, while the mortality rate has, actually, been decreasing. Behind this favorable trend in the decrease in mortality are not only high-quality screening programs, but also undoubtedly advances in therapy, especially new methods in surgical treatment. The importance of oncoplastic approach integrating resection and reconstruction procedures is obvious. Our efforts continue to maximize breast-conserving therapy, which is being improved in parallel with the development of new localization methods of non-palpable lesions. Breast-conserving therapy indication spectrum is also increasing with the use of oncoplastic approach allowing the resection of a significant part of the mammary gland while achieving an acceptable cosmetic result. We improve guidelines for skin-sparing procedures and also possibilities and availability of breast reconstruction. Most popular is breast reconstruction with free abdominal flap transfer. However, due to such demanding complex procedure with limited availability, there is also a significant development of silicone-implant-based reconstruction or methods of fat transfer. Constant attention is focused on axillary surgery, now especially in cases of initial nodal involvement that responds favorably to neoadjuvant systemic treatment. Current findings indicate tendency to modify and differentiate surgical indications according to the tumor phenotype. Complex lymphedema prevention surgery, such as lymphatic mapping or restoring lymphatic flow via microsurgical lymphaticovenous anastomosis, can provide effective and long-term improvement and is challenging. Recently in the Czech Republic, we reopened the discussion about the optimal concentration ofmedical care in a smaller number of specialized breast centers, which we think is one of a number of steps on the constant path to improve medical results.