Lipofilling Procedures Research Articles

Breast Lipofilling: Is the Bra Really Full? Clinical Bra Pressure Measurement and In Vitro Testing of Processed and Unprocessed Fat Cells.

Breast lipofilling, a popular cosmetic and reconstructive procedure, involves the transplantation of autologous fat to enhance breast volume and contour. Despite its widespread use, cell processing and the aftertreatment remain controversial. This study investigates the pressure applied by a compression bra and reports in vitro stress tests of processed and unprocessed fat cells. Clinical bra pressure measurements were conducted on a cohort of 45 patients following lipofilling, reduction mammoplasties and DIEP flaps. Laboratory analysis included cell vitality testing using Resazurin assays of processed and unprocessed fat cells after exposure to mechanical or hyperbaric pressure. Our findings show a mean overall pressure value of the compression bra for all patients of 6.7 ± 5.7 mmHg (range 0-35). Cell processing is superior to sedimentation only regarding fat cell vitality. However, neither mechanical pressure within the specified range nor hyperbaric oxygen exposure significantly affected fat graft survival as measured by Resazurin assays. The in vitro measurements showed that it was impossible to harm fat cells with external pressure during lipofilling procedures, regardless of their processing. In the clinical context, the compression bra applied pressure values deceeding the perfusion pressure and may therefore not diminish oxygen supply nor harm the transplanted cells. Therefore, we recommend the use of a compression bra for all lipofilling procedures around the breast. 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 online Instructions to Authors www.springer.com/00266.

The optimized priming effect of FGF-1 and FGF-2 enhances preadipocyte lineage commitment in human adipose-derived mesenchymal stem cells.

The cell-assisted lipotransfer technique, integrating adipose-derived mesenchymal stem cells (ADMSCs), has transformed lipofilling, enhancing fat graft viability. However, the multipotent nature of ADMSCs poses challenges. To improve safety and graft vitality and to reduce unwanted lineage differentiation, this study refines the methodology by priming ADMSCs into preadipocytes-unipotent, self-renewing cells. We explored the impact of fibroblast growth factor-1 (FGF-1), fibroblast growth factor-2 (FGF-2), and epidermal growth factor (EGF), either alone or in combination, on primary human ADMSCs during the proliferative phase. FGF-2 emerged as a robust stimulator of cell proliferation, preserving stemness markers, especially when combined with EGF. Conversely, FGF-1, while not significantly affecting cell growth, influenced cell morphology, transitioning cells to a rounded shape with reduced CD34 expression. Furthermore, co-priming with FGF-1 and FGF-2 enhanced adipogenic potential, limiting osteogenic and chondrogenic tendencies, and possibly promoting preadipocyte commitment. These preadipocytes exhibited unique features: rounded morphology, reduced CD34, decreased preadipocyte factor 1 (Pref-1), and elevated C/EBPα and PPARγ, alongside sustained stemness markers (CD73, CD90, CD105). Mechanistically, FGF-1 and FGF-2 activated key adipogenic transcription factors-C/EBPα and PPARγ-while inhibiting GATA3 and Notch3, which are adipogenesis inhibitors. These findings hold the potential to advance innovative strategies for ADMSC-mediated lipofilling procedures.

Correcting facial asymmetry through guided plate assisted mandibular angle osteotomy.

Asian women prefer a smooth and narrowed mandibular appearance. The purpose of the retrospective cohort study is to evaluate guide plate-assisted mandibular angle ostectomy (MAO) in improving mandibular symmetry for Asian female patients with mandibular angle hypertrophy (MAH) with normal occlusal relationship. We retrospectively examined 11 patients with asymmetry MAH with normal occlusal relationship who received MAO at Shanghai Ninth People's Hospital between September, 2020, and January, 2022. Preoperative plans were designed based on CT data and executed using metal guide plate during the operation. Preoperative and one-week postoperative CT scans were used to assess measurements including Height_Go, Divergence_Go, ∠ZyZy-GoGo, and osteotomy volume, to evaluate symmetry. For precision, compare the postoperative CT with the preoperative design, assessing osteotomy distance, angle, and volume error. Patient satisfacation was evaluated with Likert Scale in 6-month follow-up. Secondary lipofilling procedures were given as appropriate. Statistical analysis was performed using paired t-tests in SPSS. The mean age of the 11 patients was 28.5 years (range 23-34 years). 2 of these underwent lipofilling procedures. No complications were observed during the following-up. Postoperative results were not statistically different from the design, demonstrating a precision of within 2 mm. Height_Go disparity within 5 mm get corrected notably, reducing asymmetry from 15.09% preoperatively to 2.74% postoperatively. Patients satisfaction was rated at 4.5 out of 5 in 6 month follow-up. Guide plate-assisted mandibular angle osteotomies achieve effective and precise surgery. This approach demonstrates a safe option for correction for mandibular asymmetry, achieving patient satisfaction.

Latissimus Dorsi Flap and Thoracodorsal Artery Perforator Flap with Immediate Fat Transfer (LIFT and TIFT): A Retrospective Study about Total Breast Reconstruction in High-Risk Patients.

Microsurgical breast reconstruction has become popular over the past twenty years and allows a tailor-tuck approach to each patient. However, smoking or coagulation disorders may switch surgeon's choice towards alternative options. When facing these risk factors, we performed pedicled latissimus dorsi (LD) flap and thoracodorsal artery perforator (TDAP) flap reconstruction with immediate fat transfer (LIFT and TIFT), achieving satisfactory surgical outcomes. Hence, we aim to present our seven-years case-series and discuss our decisional algorithm. Thirty smoker women and seven women affected by coagulation disorder (n = 37) respectively had LIFT and TIFT surgery and were retrospectively evaluated. Patients' demographics and outcomes were recorded and compared. LIFT patients received higher volumes of immediate fat grafting compared to TIFT patients (p < 0.05), which required additional lipofilling to provide adequate volume amount, since the TDAP flap was not immediately grafted. However, the additional lipofilling procedures and fat volume were similar (p > 0.05). Flap survival reached 100%, and flap necrosis or loss did not occur. Few minor complications were evidenced in the LIFT group only (p > 0.05). Based on our experience, we support the reliability of pedicled LD and TDAP flaps with immediate fat transfer in breast reconstruction as valuable alternative to microsurgery in smokers (LIFT) and patients with coagulation disorders (TIFT). However, the results of our study are not conclusive since still must be clarified the role of the smoking and coagulation disorders in microsurgery and the real benefit of a non-microsurgical procedure. Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. 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 .

Primary lipofilling as an adjunct in transverse upper gracilis flap breast reconstruction

In many centres, the myocutaneous transverse upper gracilis (TUG) flap represents an alternative choice in autologous breast reconstruction when abdominal tissue is unavailable. However, a single TUG flap may be volume deficient, particularly in the upper pole. We describe the application of simultaneous lipofilling to the pectoralis major muscle at the index procedure and present our decision-making algorithm, technique and outcomes. A retrospective review of all TUG flaps between January 2011 and May 2021 was conducted. Patient demographics, volume of primary and any subsequent fat grafting and complications were recorded. A total of 183 patients (242 TUG flaps) were included in this study. Of these; 130 patients were reconstructed with single TUG flaps, 16 patients received a single TUG flap with immediate lipofilling, and 37 patients underwent stacked, double TUG flap reconstructions. Of the 242 flaps, there were 2 flap losses (<1%), neither of which occurred in the immediate lipofilling cohort. Among the 130 single TUG patients, 28 (21.5%) required a cumulative total of 40, and a mean of 1.4, secondary lipofilling procedures. The immediate lipofilling patients were injected with a mean of 42ml fat (range: 20-80ml). In this group, only 2 of 16 patients required secondary lipofilling. The mean follow-up was 67 months (17-141). Primary lipofilling may reduce the need for secondary revisional procedures and appears safe at the index operation, adds little operative time and has negligible donor site morbidity. In patients where a second (stacked) flap would add unnecessary volume and complexity, it can be considered a useful adjunct.

Effective or Harmful-Evaluation of Locally Applied Antibiotics on Adipose Tissue during Lipofilling to the Breast-An In Vitro Study.

Lipofilling is a frequently used and safe procedure for breast reconstruction. One of the most feared complications is soft tissue infection following lipofilling. Because of this, some surgeons propose the practice of rinsing fat grafts with antibiotics. This study investigates the effect of antibiotic rinses on fat grafts in an in vitro model. Adipocytes and stem cells were isolated from fat tissue harvested during 24 lipofilling procedures and incubated with different doses of clindamycin or cefazolin. Cell viability, metabolism, proliferation, and differentiation capacities were analyzed by gross morphology, fluorescence staining, -(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromid (MTT-), and Glyceraldehyde 3 Phosphate Dehydrogenase (G3PD)-assay as well as reactive oxygen species (ROS)-assay. Cefazolin and clindamycin led to significant reduction of cell viability of adipocytes. High doses of both antibiotics led to a rupture of adipocytes with visible free lipid droplets. Cell metabolism was significantly decreased after incubation with both antibiotics. There was a significant increase in ROS production. Exposure to clindamycin and cefazolin led to morphological changes in stem cells in a dose- and time-dependent manner. Furthermore, differentiation potential was significantly reduced. Antibiotic susceptibility testing, however, showed that low concentrations of antibiotics effectively inhibited bacterial growth in contaminated fat grafts. This study confirms that rinsing fat grafts with clindamycin or cefazolin not only overly prevents infection but also has cytotoxic and metabolic effects on adipocytes. Therefore, based on these results, the routine clinical application in high doses cannot be recommended.

Stem cells in plastic surgery and aesthetic medicine.

Stem cells (SCs) have multiple applications in today's medicine including aesthetic dermatology and plastic surgery. The purpose of this paper is to review some clinical use of mesenchymal SCs. The main focus was put on adipose tissue-derived stem cells (ADSCs) as these cells are easy to harvest and because of their properties showed great potential in many studies, where they proved to accelerate wound healing, reduce scars, cause hair regrowth, or rejuvenate skin. Furthermore, when added to lipofilling procedures, such as breast augmentation they enhance fat graft survival and provide satisfying results. Currently, many different strategies for using SCs in treatments are developed with great efficacy, however, there are still many limitations and concerns regarding their clinical use.

The effect of radiotherapy on fat engraftment for complete breast reconstruction using lipofilling only

PurposeLipofilling has been established as a standard technique for contour enhancement following breast reconstruction. However, there is a paucity in current literature regarding the use of this technique for complete reconstruction of the female breast as an alternative to conventional techniques, such as expander or flap-based procedures. In particular, the influence of pre-operative irradiation for successful reconstruction has rarely been examined in published studies. Here, the authors describe their experience with successful fat injection in pre-radiated breasts in comparison with non-pre-radiated patients.MethodsIn this retrospective study, we examined a total of 95 lipofilling treatments on 26 patients (28 breasts). All of them experienced mastectomy following breast cancer; local breast defects after partial resection of the gland were not included in this study. In total, 47 lipofilling procedures in 12 non-irradiated patients (14 breasts) and 48 procedures in 14 irradiated women (also 14 breasts) were performed. Per session, approximately 297 ± 112 cc of adipose tissue was grafted in group A (no radiotherapy) and approximately 259 ± 93 cc was grafted in group B (radiotherapy).ResultsAmong the group of women without pre-operative radiation, 71% of breast reconstructions limited to lipofilling only showed constant engraftment of fat tissue with a successful reconstructive result, whereas only 21% of the patients with pre-radiated breasts showed complete reconstruction of the breast with a permanent fat in-growth.ConclusionPreoperative radiotherapy significantly impedes successful completion of breast reconstructions planned only by autologous fat transfer. Patients should be selected individually and carefully for complete breast reconstruction using lipofilling only.

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

PurposeThe transverse musculocutaneous gracilis (TMG) flap is as a valuable alternative in autologous breast reconstruction. The purpose of this study was to evaluate the donor site morbidity and secondary refinement procedures after TMG flap breast reconstruction.MethodsA retrospective study was conducted, including all patients who received TMG flap breast reconstructions, from January 2012 to August 2019. Primary outcomes were surgical site complications of the donor site and secondary refinement procedures carried out for aesthetic or reconstructive purposes for the medial thigh. Secondary outcomes of interest were lipofilling procedures for optimization of the reconstructed breasts.ResultsNinety-nine patients received 159 TMG flaps for breast reconstruction. Patients’ mean BMI was 23.5 (15.6–32.5) kg/m2. Bilateral breast reconstructions were performed in 60.6%. The mean flap volume was 330 (231–440) g. Surgical site complications occurred in 14.5% of the TMG donor sites and wound dehiscence was the most common complication (9.4%). Lymphedema occurred in 1.8% of the donor thighs. Aesthetic refinement procedures were performed in 25.2% on the donor thigh or contralateral thigh. Secondary lipofilling was performed in 54.1% of the reconstructed breasts and fat was harvested in only 11.9% from the legs.ConclusionThe TMG flap breast reconstruction combines low donor site morbidity with adequate volume for appealing breast results, particularly in slim-to-normal weight patients. However, patients should be informed about the likelihood of secondary refinement procedures on the donor site and the need of lipofilling to optimize the breast shape and volume.

Chirurgie secondaire des reconstructions mammaires par prothèses. Évaluation de la satisfaction des patientes selon la technique chirurgicale : conservation d’implant vs conversion autologue

Breast reconstruction with implants has long-term disadvantages and is leading an increasing number of patients to request secondary corrective surgery. Two surgical strategies are possible: implant replacement (associated with capsulectomy/capsulotomy and/or lipofilling procedures) and implant removal associated with the provision of autologous tissue (flap and/or lipofilling). Between 2010 and 2018, 54 patients underwent secondary surgery for correction of a first implant breast reconstruction. The reasons for dissatisfaction with the initial reconstruction, the procedures performed, and postoperative complications were analysed. Patient well-being and satisfaction were evaluated using the BREAST-Q questionnaire. Thirty-four patients benefited from a prosthesis change and 20patients benefited from a permanent removal of their prosthesis combined with the addition of autologous tissue. The presence of a periprosthetic shell, pain, fixed appearance of the breast and breast asymmetry were the most frequent reasons for dissatisfaction. With a mean follow-up of 2.6years, autologous conversion patients were generally more satisfied with the appearance of their breasts than patients who retained a breast implant (P<0.0001). In cases of poor esthetic or functional outcomes of implant-based breast reconstruction, removal of the prosthesis in combination with autologous reconstruction provides better results in terms of well-being and satisfaction than implant replacement.

Lipofilling of the upper eyelid to treat paralytic lagophthalmos

Lagophthalmos is one of the most unpleasant and dangerous conditions that affect patients with facial palsy. The lack of ocular protection leads to corneal problems (such as conjunctival infections, acute and chronic keratitis, corneal ulcerations, and blindness). A dynamic reanimation of blinking eyelids is the therapeutic gold standard. However, success is not guaranteed with these dynamic techniques; even if results are good, blinking is usually restored within a year of the initial operation. Procedures that act more rapidly and have a higher success rate are needed. We proposed that lipofilling of the upper eyelid would improve eye closure, exploit the advantages of using autologous fat, and avoid the risks of exposure or migration associated with loading the lid with gold. Between 2012 and September 2018, we did upper eyelid lipofilling procedures for 75 patients with unilateral facial palsy. The main favourable result of lipofilling of the upper lid was the immediate improvement in corneal discomfort. Everybody described a partial to total increase in corneal comfort postoperatively. In the treatment of paralytic lagophthalmos, lipofilling of the upper eyelid produces favourable aesthetic and functional results, ocular health is restored, and the patients' quality of life is improved.

Oncological Safety of Lipofilling in Healthy BRCA Carriers After Bilateral Prophylactic Mastectomy: A Case Series.

The germline breast cancer gene (BRCA) mutation confers a lifetime high risk for breast cancer (BC) and bilateral prophylactic mastectomy is the procedure which allows the highest risk reduction rate. Among other techniques, lipofilling (LF) can be used for breast reconstruction of these patients. However, there are some oncological safety concerns on the subject. The purpose of this study was to assess the oncological risk of LF in BRCA healthy patients. A single institution case series was built including BRCA I/II mutated patients with no previous history of BC, who underwent bilateral prophylactic mastectomy followed by breast reconstruction with exclusive LF or combined with implants or latissimus dorsi flap. Data were collected regarding patient demographics, clinical information, reconstruction techniques used, and fat grafting details. From September 1999 till November 2017, we identified 18 BRCA carriers with no history of BC who had undergone bilateral prophylactic mastectomy, followed by breast reconstruction with LF. A total of 36 LF procedures were performed following an implant or latissimus dorsi flap, or as an exclusive fat grafting breast reconstruction. The average number of LF sessions was 1.4 with a mean volume of 108.8cc per breast. Median follow-up was 33.0 months after mastectomy and 24.5 months after the last LF intervention; no patients were diagnosed with BC during follow-up. Germline BRCA mutation is a high-risk plight for BC. However, despite the limited follow-up, no BC was detected.

Does lipofilling after oncologic breast surgery increase the amount of suspicious imaging and required biopsies?-A systematic meta-analysis.

The aim of our systematic meta-analysis was to find out if lipofilling to the breast alters follow-up imaging procedures and leads to an increased number of biopsies because of suspicious findings. We conducted a systematic meta-analysis of the literature including all prospective and retrospective studies focusing on imaging outcomes in patients with a history of breast cancer who have received one or more lipofilling procedures after oncologic surgery to the breast. Twelve studies met the inclusion criteria, comprising 1711 patients and at least 2261 lipofilling procedures. 564 patients (33%) were followed up only with ultrasound, 735 patients (43%) only received mammography, 273 (16%) had a combination of ultrasound, mammography and MRI, and 37 patients (2.1%) were followed up via ultrasound and mammography. A collective of 102 patients making up a matched-cohort study received ultrasound, mammography, MRI, and PET/CT, while only 51 of them made up the investigation group who had autologous fat grafting (3%). Biopsy rates were 1%-24% with a medium of 6.5% over all groups. Medium follow-up was 18.8months (range 6-50months). The rate of local oncologic events among the patients with lipofilling procedures detected during the study periods was 0.7%. Lipofilling to the breast after oncologic operations appears to be a safe procedure with overall low biopsy and local recurrence rate. Suspicious imaging occurs in most cases out of physiologic remodeling and inflammation processes at the operation site and needs to be distinguished from malignant focusses. The amount of required biopsies stands in relation to the used imaging method and the time to follow-up.

Volumetric Analysis of Fat Injection by Computerized Tomography in Orthognathic Surgery: Preliminary Report on a Novel Volumetric Analysis Process for the Quantification of Aesthetic Results.

Integrated approaches to orthognathic surgery should include accurate volumetric evaluation of the skull and soft tissues. In patients with dentofacial deformities, the most frequent aesthetic deficits are attributable to an underdevelopment of hard and soft tissues. Traditional osteotomic procedures often fail to guarantee a stability of soft tissues over time. For this reason, in selecting a surgical strategy, the surgeon should consider not only traditional osteotomies, but also soft-tissue improving procedures, such as lipofilling. Preoperative surgical planning systems, such as the Virtual surgical planning (VSP) protocol, are based mainly on skeletal movement prediction. Quantitative estimation of soft-tissue modifications is not part of common clinical practice. Most commonly, the evaluation of soft-tissue modifications after orthognathic procedures is instead performed by clinical qualitative means.The purpose of this study was to describe a novel computed tomography (CT)-based volumetric analysis process for the quantification of injected autologous adipose tissue in patients who have undergone simultaneous orthognathic and lipofilling procedures. This was a retrospective review of consecutive patients who underwent combined orthognathic surgery and lipofilling from June 2016 to May 2017 for malocclusion with functional and aesthetic impairments. Preoperative planning included clinical evaluation and virtual osteotomy planning according to the VSP protocol. The volume of fat to be injected was estimated clinically by comparing virtual renderings with preoperative clinical photographs. The surgical technique involved Le Fort I and sagittal split mandibular osteotomies, combined with autologous fat injection in the malar and perioral regions. Postoperative evaluation was performed with a novel imaging process based on CT image segmentation to quantify the exact volume of injected fat. Skeletal stability was also evaluated at 3 months. Sixteen patients were enrolled in the study, all females, with a mean age of 24.5 years (range, 18-36 years). The mean difference between the fat tissue injected and that quantified postoperatively was 6.01 cm. All patients had clinically satisfactory facial convexity, with complete restoration of the cheekbone contour, at 3 months. This study introduces a novel CT-image based technique to quantitatively assess the contribution of injected fat to the postoperative soft-tissue volume increase after combined orthognathic surgery with autologous lipofilling. In the future, this CT-based volumetric analysis technique could be the gold standard for evaluating facial lipofilling outcomes, and for assessing clinical aesthetic outcomes based on the injected volume of fat.

Micro-Autologous Fat Transplantation Combined With Platelet-Rich Plasma for Facial Filling and Regeneration: A Clinical Perspective in the Shadow of Evidence-Based Medicine.

Despite the popularity of lipofilling procedures in recent years, the presence of older habits still in fat graft harvesting and processing seems to be the biggest obstacle to the final better outcome of fat grafting. Our study is aimed to highlight some strategies what should be done in fat grafting in the shadow of evidence-based medicine and patient-reported outcomes which might be of interest to the clinicians. Between 2015 and 2017, 14 patients were included who underwent facial micro-autologous fat transplantation with platelet-rich plasma injection. The outcome was determined by the difference in presurgery and postsurgery FACE-Q modules, which were designed as patient-reported outcome instrument to evaluate the unique outcomes of patients undergoing facial cosmetic procedures. Surveys conducted were modules of satisfaction with facial appearance, satisfaction with cheeks, satisfaction with skin, psychological function, social function, aging appearance appraisal, and satisfaction with the outcome. All patients were followed up minimum 9 months. No major complications were recorded. The patient-reported FACE-Q satisfaction and FACE-Q quality-of-life presurgery and postsurgery results showed statistically significant improvement (<0.001). Overall satisfaction with the outcome was 87.6 ± 16.8 (range 55-100). A combination of platelet-rich plasma and micro-fat grafting with soft harvesting and processing could be seen a good surgical technique to restore volume and enhance skin quality in facial soft tissue augmentation. The authors believe that with minimum detrimental effect on fat grafting while harvesting, processing, and with the addition of platelet-rich plasma while applying may increase the surgeon's and patient's satisfaction with the outcome.

Relationship between Tamoxifen and the Absorption of Subfascial Autologous Fat Grafts.

In the lipofilling procedures used in breast reconstruction, there is an unpredictability in the rate of reabsorption of the grafted fat. The objective of this study was to analyze the effect of tamoxifen, a medication commonly prescribed for patients with breast cancer, as a possible alternative to reduce the rate of autologous fat graft resorption. The fatty cushion of the inguinal region of 20 female adult Wistar rats was removed and then autografted, using a standard volume of 0.2 ml in the subfascial plane of the dorsal region. The subject animals were randomized into two groups, the control and study groups. The study group animals were administered 20 mg/kg/day of tamoxifen citrate over a period of 21 days, by means of gavage. At the end of the experiment, the animals were killed and the grafts underwent morphologic and histopathologic analysis, with emphasis on the predominant inflammatory response pattern and collagen maturation. The rats undergoing treatment with tamoxifen (study group) presented higher values in relation to the weight and volume of fat grafts compared with the initial values and the control group. Histologic analysis using hematoxylin and eosin staining showed that resolution of the inflammatory process was faster in the control group. Analysis using the picrosirius method demonstrated higher percentages of immature collagen versus mature collagen. Use of tamoxifen reduced the rates of resorption and fibrosis of the injected fat, resulting in better integration of the autologous fat graft.

Orthognathic surgery “again” to correct aesthetic failure of primary surgery: Report on outcomes and patient satisfaction in 70 consecutive cases

PurposeAn increasing number of patients complain about unsatisfactory aesthetic outcomes of orthognathic surgery, desiring reoperation to improve facial aesthetics. The aims of this article are to present a wide range of aesthetic reasons to justify a secondary orthognathic surgery and to report aesthetic outcomes and patient satisfaction after reoperation. Material and methodsThis research covers 70 consecutive patients who underwent a secondary bimaxillary orthognathic surgery with simultaneous facial lipofilling procedures between January 2006 and December 2015. The screening criteria are described for patient selection, the diagnostic process, surgical procedures, and outcomes. Pre- and postoperative facial appearances are compared. Postoperatively, patients were asked to state the improvements perceived in their facial appearance and their satisfaction with the aesthetic outcomes. ResultsAfter reoperation, all patients showed a full Class I occlusion. Major complications did not occur. According to the clinicians' evaluation, a postoperative evident aesthetic improvement was achieved in 65 patients (92.9%), and 64 patients (91.4%) were satisfied with the aesthetic outcomes achieved. ConclusionSecondary orthognathic surgery performed in conjunction with facial lipofilling procedures in most cases led to satisfactory aesthetic outcomes. A very accurate selection of patients, a meticulous three-dimensional diagnostic process and planning, and appropriate intra-operative maneuvers are required.

Re: "The Role of Lipofilling After Breast Reconstruction: Evaluation of Outcomes and Patient Satisfaction with BREAST-Q".

The aim of this study was to measure patient satisfaction using the BREAST-Q reconstruction module in patients selected for lipofilling procedures after implant breast reconstructions. Seventy patients who underwent breast reconstruction with or without delayed lipofilling were enrolled between 2011 and 2015, and they completed BREAST-Q surveys. We administered the questionnaire electronically 6 months and 1 year after surgery. We divided patients into two groups. In group A, we included patients (46) who underwent secondary lipofilling almost 1 year after implant-based breast reconstruction; in group B (24), patients who underwent implant-based breast reconstruction without any lipofilling procedure. Statistical analysis was performed using descriptive and summary statistics to identify a central tendency between the two groups. All patients answered the postoperative BREAST-Q reconstruction module. The mean age of the patients was 41 years. Eleven of the 70 patients underwent a bilateral mastectomy. The mean follow-up was 2.5 years. The average amount of fat graft injected was 110 cc. In group A, there were two patients who had a complication: 1 infection and 1 intraoperative implant rupture. The average number of lipofilling procedures was 2.2. After further analysis of the questionnaire, we observed that patients in group A obtained significantly better postoperative results than patients from group B (control) regarding the following items: the ability to wear more fitted clothing; the reconstructed breast softness; symmetry (breasts of equal size relative to the other); reconstructed breast look and touch; amount of implant rippling perceived by the patients; and psychosocial well-being and physical well-being: chest and upper body. Our results are encouraging regarding the use of autologous fat grafting to improve cosmetic outcomes and to reduce postoperative pain after breast reconstruction. This is the first study that applied BREAST-Q to breast lipofilling to demonstrate better outcomes achieved by patients who underwent secondary lipostructures. 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 .

Lipofilling effects after breast cancer surgery in post-radiation patients: an analysis of results and algorithm proposal

BackgroundLipofilling or autologous fat transfer is an established technique in plastic surgery. Herein, we describe the lipofilling effects after implant-based breast reconstruction in post-radiation patients and propose an algorithm for indication of lipofilling.MethodsForty patients with a history of breast cancer were included in this retrospective analysis. Patients had undergone either breast conserving therapy or mastectomy. Twenty-six patients underwent additional radiation therapy. Patients were assessed using a post-radiation skin scoring classification.ResultsIn total, 68 lipofilling procedures were analyzed. Scar release, skin softening, improved quality of life, and improvement of post-radiation findings are results of lipofilling with a closed filtration system. In all patients with post-surgical radiation, an improvement of tissue quality was observed. Staging revealed that lipofilling improved mean post-radiation skin scores of 2.40 ± 0.89 to 1.21 ± 0.76 (p ≤ 0.000). There was no recurrence of breast cancer in our study patients.ConclusionsThis study introduces an algorithm using lipofilling in reconstructive breast surgery and especially in post-radiation patients with low risks as well as very high acceptance in patients with various indications for this procedure. A regenerative aspect was also detectable in patients following radiation therapy and reconstruction. Lipofilling is a safe and effective procedure with a low incidence of minor complications. It is therefore a feasible method to resolve volume deficiencies and asymmetric results after oncologic breast surgery. Nevertheless, a prospective study has now been initiated focusing on the oncologic safety of lipofilling including ultrasound and radiological examinations to validate the findings of this initial study.Level of Evidence: Level IV, therapeutic study.

Abstract: 10.30 Intratissular Expansion And Layered Fat Grafting In Autologous Breast Reconstruction

INTRODUCTION: Breast reconstruction involves the use of autologous tissue or implants. However, fat grafting seems the ideal technique because of its minimally invasive character but the challenge is to reconstruct a 3D, homeostatic tissue construct using a liquefied tissue (lipoaspirate) as building blocks. MATERIALS AND METHODS: Total breast reconstruction (n=7) was performed with intratissular expansion and serial lipofilling sessions. Mean age of the patients was 41 years old (22–53). A prepectoral positioned expander created skin expansion and induced the formation of a peri-prosthetic capsule with boundary conditions between the outer skin envelope and the well-vascularized capsule. The vascular plexus in the outer layer of the capsule functioned as a vascular source. Serial deflation and fat grafting sessions were initiated at 8 weeks with an interval of three months until the desired volume was obtained. The expander was removed during the last session. The fat grafting procedure consisted of manual liposuction and processing following the Coleman protocol. An average of 644cc (range 415 _ 950cc) of lipoaspirate material was injected to reconstruct the breast with an average of 4 (range 3–5) fat grafting sessions. Average follow-up was 14 months (range 9–29 months). RESULTS: All patients completed the treatment successfully with a pleasing, stable, prepectoral breast reconstruction. Magnetic resonance imaging examination showed a mean breast volume of 378cc (range 218 _ 557cc) and retained no tissue necrosis. One infection occurred which necessitated temporary removal of the expander. There were no adverse effects related to the lipofilling procedures. CONCLUSIONS: In a selected group of patients we have been able to reconstruct an aesthetically pleasant and stable breast mound with intratissular expansion and fat grafting with rather predictable results. Further refinements include the incorporation of a nutritional matrix to enhance the survival rate of fat grafts and reduce the number of fat graft sessions.