Oil Cyst Research Articles

Lipolysis inhibition improves the survival of fat grafts through ameliorating lipotoxicity and inflammation.

Fat grafting is a promising technique for correcting soft tissue abnormalities, but oil cyst formation and graft fibrosis frequently impede the therapeutic benefit of fat grafting. The lipolysis of released oil droplets after grafting may make the inflammation and fibrosis in the grafts worse; therefore, by regulating adipose triglyceride lipase (ATGL) via Atglistatin (ATG) and Forskolin (FSK), we investigated the impact of lipolysis on fat grafts in this study. After being removed from the mice and chopped into small pieces, the subcutaneous fat from wild-type C57BL/6J mice was placed in three different solutions for two hours: serum-free cell culture medium, culture medium+FSK (50 μM), and culture medium+ATG (100 μM). Following centrifugation to remove water and free oil droplets, 0.3 mL of the fat particles per mouse was subcutaneously injected into the back of mice. Additionally, the subcutaneous fat grafting area was immediately injected with PBS (control group), ATG (30 mg/kg), and FSK (15 mg/kg) following fat transplantation. Detailed cellular events after grafting were investigated by histological staining, real-time polymerase chain reaction, immunohistochemistry/immunofluorescent staining, and quantification. Two weeks after grafting, grafts treated with ATG showed lower expression of ATGL and decreased mRNA levels of TNFα and IL-6. In contrast, grafts treated with ATG showed elevated expression levels of IL-4 and IL-13 compared to the control grafts. In addition, fewer apoptotic cells and oil cysts were observed in ATG grafts. Meanwhile, a higher CD206+/CD68+ ratio of macrophages and more CD31+ vascular endothelial cells existed in the 2-month ATG grafts. In comparison to the control, ATG treatment improved the volume retention of grafts, and decreased graft fibrosis and oil cyst formation. By preventing oil droplet lipolysis, pharmacological suppression of ATGL shielded adipocytes from lipotoxicity following grafting. Additionally, ATG ameliorated the apoptosis and inflammation brought on by adipocyte death and oil droplet lipolysis in grafted fat. These all indicate that lipolysis inhibition improved transplanted fat survival and decreased the development of oil cysts and graft fibrosis, offering a potential postoperative pharmacological intervention for bettering fat grafting.

Fat necrosis: A consultant's conundrum.

Fat necrosis of the breast is a benign non-suppurative inflammation of the adipose tissue and often mimics breast cancers, posing a diagnostic challenge for the clinician and radiologist. It has a myriad of appearances on different imaging techniques, ranging from the pathognomic oil cyst and benign dystrophic calcifications to indeterminate focal asymmetries, architectural distortions, and masses. A combination of different modalities can assist a radiologist in reaching a logical conclusion to avoid unnecessary interventions. The aim of this review article was to provide a comprehensive literature on the various imaging appearances of fat necrosis in the breast. Although a purely benign entity, the imaging appearances on mammography, contrast-enhanced mammography, ultrasound, and magnetic resonance imaging can be quite misleading, especially in post-therapy breasts. The purpose is to provide a comprehensive and all-inclusive review on fat necrosis with a proposed algorithm allowing a systematic approach to diagnosis.

Condensing of Low-Density Fat by Mechanical Process Improves Fat Retention and Reduces Oil Cyst Formation in Breast Reconstruction.

Although autologous fat grafting is a useful adjunct for breast reconstruction, its indications remain limited as large-volume fat grafting results in high absorption and complication rates. Low-density fat includes small numbers of viable cells and considerable oil, resulting in nodules and oil cysts. This study evaluated the volumization effect and complications with combined fat grafting of condense low-density fat and high-density fat. This retrospective, single-center study included 25 patients who underwent combined grafting of condensed low-density fat and high-density fat (CLDF + HDF) and 20 patients who underwent conventional Coleman fat grafting for breast reconstruction from December 2017 to January 2022. Retention rates and complications were evaluated by magnetic resonance imaging and ultrasound rates. Patient satisfaction was evaluated using a typical Likert scale. Photographs were taken and imageological examinations were performed before and after treatment. Graft retention rate was higher in patients who underwent CLDF + HDF than Coleman fat grafting for breast reconstruction (38.40 ± 4.41% vs. 31.43 ± 5.43%, p <0.05). One patient in the CLDF + HDF grafting group, compared with twelve in the Coleman fat grafting group, developed oil cysts exceeding 1 cm. Patient satisfaction rate was higher in the CLDF + HDF grafting group. Mechanical processes can concentrate the cellular content of LDF and remove oil, condensing LDF to the level of HDF. Combined grafting of CLDF optimized by mechanical processing and HDF is effective for breast reconstruction, with a higher retention rate and a lower incidence of complications than conventional Coleman fat grafting. 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 .

Oncologic Safety in Autologous Fat Grafting Reconstruction after Breast Conservation Treatment: A Systematic Review and Meta-analysis

PURPOSE: Autologous fat grafting (AFG) reconstruction is a widely used method to correct defects after breast conservation treatment (BCT) that has gained popularity within the last decade. Even though it results in aesthetically pleasing outcomes with minimally invasive surgery, the oncological outcomes of the procedure are still being researched. The purpose of this systematic review is to analyze the literature to compare BCT and AFG versus BCT only with cancer recurrence and procedure complications. METHODS: The systematic review was conducted using the PubMed Database with articles from 1970 to 2021. The main search terms used were ‘mammaplasty’, ‘breast conservation’, ‘breast cancer’, ‘fat grafting’, and ‘neoplasm recurrence.’ The inclusion criteria were fat grafting only, partial breast reconstruction, and cancer recurrence. The exclusion criteria were all full breast reconstruction procedures. The statistical analysis was done using patients who received AFG versus no AFG in the BCT population in order to compare complications, cancer recurrence, and metastasis. RESULTS: The PubMed search strategy yielded a total of 146 articles. After applying inclusion and exclusion criteria, a total of 15 articles were used for analysis, with a total of 900 BCT only patients and 1063 BCT AFG patients. Based on the pooled meta-analysis, in the BCT only patients, 4.8% had cancer recurrence and 4.8% had metastasis, and for the BCT and AFG patients, 3% had cancer recurrence and 6.9% had metastasis. The average length of follow up time for BCT only is 58.73 months and for BCT and AFG is 55.24 months. Patients with BCT only versus BCT and AFG showed no statistically significant difference in total cancer recurrence (P=0.99), local cancer recurrence (P=0.84), and metastasis (P=0.36). The fat necrosis and oil cyst rate for BCT only was 21.3 % and for BCT and AFG it was 19.2%. The complication rates for fat necrosis and oil cysts were not statistically different between BCT versus BCT and AFG (P=0.44). CONCLUSION: The results show no significant difference in cancer recurrence or metastasis in the BCT only group versus BCT and AFG, showing that fat grafting is not only an aesthetically pleasing and minimal surgery, but it has safe outcomes with no differences in complications.

Oncologic Safety in Autologous Fat Grafting Reconstruction after Breast Conservation Treatment: A Systematic Review and Meta-Analysis

INTRODUCTION: Autologous fat grafting (AFG) reconstruction is used to correct defects after breast conservation treatment (BCT). There is a lack of information about its oncological outcomes. The purpose of this study is to compare BCT and AFG vs BCT only for cancer recurrence and complications. METHODS: The systematic review via PubMed screened articles from 1970 to 2021. Inclusion criteria were fat grafting, partial breast reconstruction, and cancer recurrence. Exclusion criteria were full breast reconstruction. Statistical analysis used patients who received AFG vs no AFG among BCT. RESULTS: The PubMed search strategy yielded a total of 146 articles. After applying inclusion and exclusion criteria, 15 articles were used for analysis, with 900 BCT only patients and 1,063 BCT AFG patients. Among BCT only, 4.8% had cancer recurrence and 4.8% had metastasis, and among BCT and AFG, 3% had cancer recurrence, and 6.9% had metastasis. Average length of follow-up time for BCT only is 58.73 months and for BCT and AFG is 55.24 months. BCT only vs BCT and AFG showed no statistically significant difference in total cancer recurrence (p = 0.99), local cancer recurrence (p = 0.84), and metastasis (p = 0.36). The fat necrosis and oil cyst rate for BCT only was 21.3% and for BCT and AFG it was 19.2%. The complication rates for fat necrosis and oil cysts were not statistically different between BCT vs BCT and AFG (p = 0.44). CONCLUSION: The results show no significant difference in cancer recurrence or metastasis, showing that fat grafting has safe outcomes with no differences in complications.

A Preliminary Exploratory Study of Autologous Fat Transplantation in Breast Augmentation With Different Fat Transplantation Planes.

BackgroundAutologous fat transfer is common in breast augmentationor reconstruction. However, AFG recipient site in the breast for fat grafting has not been carefully investigated.MethodsForty female patients requiring breast augmentation with fat grafting were randomly assigned into two groups. The retromammary group received 2/3 fat into the retromammary space and the other 1/3 into the subcutaneous and retropectoral planes. The retropectoral group received 2/3 fat into the retropectoral plane and the other 1/3 into the subcutaneous and retromammary planes. The fat grafting result at 6 months was assessed by 3D laser surface scanning and then ultrasound. Any complications were recorded during follow-up. Samples from a patient who underwent fat grafting for 6 months was obtained and histological examination was conducted.ResultsNo significant difference in the retention rate after 6 months was observed between the two groups (retromammary group: 35.9% ± 6.6; retropectoral group: 39.3% ± 5.1, p = 0.1076). The retromammary grouphad a higher incidence of oil cyst formation than the retropectoral group. Histological examination showed that there were more oil cysts and mac2 positive macrophage infiltration in the fat cells in retromammary group, while retropectoral group had more small-size adipocytes.ConclusionAlthough fat grafting into the retropectoral plane did not provide a superior fat graft retention rate, it did lower the incidence of complications. The retropectoral space show great potential to become a favorable recipient site.

Preoperative Short-term High-Carbohydrate Diet Provides More High-Quality Transplantable Fat and Improves the Outcome of Fat Grafts in Mice.

Patients with a low BMI may have inadequate high-quality adipose tissue for transplantation. The influence of high-energy diets on adipose tissue and graft retention remains unknown. The authors explored inguinal fat pad alternation in mice fed on a short-time high-fat diet (HFD) or a high-carbohydrate diet (HCD) preoperatively and the morphological and histological differences after transplantation. Mice were fed HFD (60% kcal from fat, 20% from carbohydrate), HCD (9.3% kcal from fat, 80.1% from carbohydrate), or normal (12% kcal from fat, 67% kcal from carbohydrate) diets for 2 or 4 weeks. Histological analyses were carried out following hematoxylin and eosin staining as well as CD34 and proliferating cell nuclear antigen immunostaining. The uncoupling protein-1 expression was determined by western blotting. Fat pads from each group were grafted into the dorsal region of the recipient mice, and morphological and histological changes were determined 4, 8, and 12 weeks posttransplantation. Vascular endothelial growth factor-α and platelet-derived growth factor-α expression were determined using quantitative polymerase chain reaction. The inguinal fat pad volume increased in the HFD and HCD groups. The presence of multilocular adipocytes in inguinal fat of HCD-fed mice, combined with the increased uncoupling protein-1 content, suggested adipocyte browning. HCD grafts showed higher volume retention and reduced oil cyst formation, possibly attributed to better angiogenesis and adipogenesis. HCD enlarged adipose tissue and improved graft survival rates, which may be due to the browning of fat before grafting and enhanced angiogenesis after grafting.

Oil Cyst Formation after Lower Blepharoplasty with Fat Grafts.

Fat grafting is increasingly used as an adjuvant surgery to blepharoplasty to refill the volume loss of an aged face and promote cellular regeneration. Complications, such as hematoma, infection, seroma, and palpable mass, may occur. We collected the patients that underwent lower blepharoplasty combined with fat graft to evaluate the incidence of oil cyst formation in the lower eyelid and to identify risk factors. A retrospective review was performed of all patients who underwent lower or total blepharoplasty combined with fat graft at the authors' institution between January 2018 and June 2020. Complication rates were observed, and associations between preoperative variables and outcomes were assessed. A total of 119 patients were included in the series (all bilateral, 238 eyelids). The average patient age was 54.88 ± 11.94 years, and the average grafted fat was 1.88 ± 1.0 mL. On a per-eyelid basis for all patients, the complication rate of oil cyst formation was 6.72% (16 of 238 eyelids). The occurrence of oil cyst formation was associated with hypertension (P = 0.012; adjusted odds ratio, 9.27; 95% confidence interval, 1.62-52.99) and diabetes mellitus (P = 0.005; adjusted odds ratio, 14.02; 95% confidence interval, 2.22-88.45), but not associated with anticoagulants use (P = 0.931), age (P = 0.784), sex (P = 0.317), or fat volume (P = 0.215). The mean interval between the fat graft procedure and oil cyst noted was 236.5 ± 118.9 days. Oil cyst in lower eyelid can be defined as a palpable, firm, and persistent subcutaneous cystic lesion found postoperatively in any size during physical examination. The complication rate of oil cyst formation occurring after lower blepharoplasty with autologous fat grafting is 6.72%. Hypertension and diabetes mellitus maybe are risk factors of oil cyst formation. Steroid injection, needle capsulotomy, liposuction, and excision are safe and effective treatments. Reduce surgical trauma by diminishing anterior lamina trauma and capsulopalpebral fascia repair might decrease the complication rate of oil cyst formation.Transconjunctival lower blepharoplasty with fat graft or 2-stage surgery may be a choice to prevent oil cyst formation.

Autologous Fat Grafting to the Breast: An Educational Review.

Autologous fat grafting (AFG) is a technique that is increasingly utilized in breast cosmetic and reconstructive surgery. In this procedure, fat is aspirated by liposuction from one area of the body and injected into the breast. The procedure and process of AFG has evolved over the last few decades, leading to more widespread use, though there is no standard method. Autologous fat grafting is generally considered a safe procedure but may result in higher utilization of diagnostic imaging due to development of palpable lumps related to fat necrosis. Imaging findings depend on surgical technique but typically include bilateral, symmetric, retromammary oil cysts and scattered dystrophic and/or coarse calcifications when AFG is used for primary breast augmentation. More focal findings occur when AFG is used to improve specific areas of cosmetic deformity, scarring, or pain following breast cancer surgery. As with any cause of fat necrosis, imaging features tend to appear more benign over time, with development of rim calcifications associated with oil cysts and a shift in echogenicity of oil cyst contents on ultrasound towards anechoic in some cases. This article reviews the AFG procedure, uses, complications, and imaging findings.

Breast Auto-augmentation (Mastopexy and Lipofilling): An Option for Quitting Breast Implants.

Breast augmentation with implants is one of the most commonly performed plastic surgical procedures, but has potential complications-asymmetry, implant displacement, rippling and wrinkling, capsular contracture, late seromas, and benign and malignant tumors-and potential financial costs. The auto-augmentation procedure, with mastopexy and lipofilling, is a second option to offer to patients who do not desire to continue with breast implants in secondary procedures. This study aimed to present a series of patients who intended to quit having breast implants, and they went to an auto-augmentation procedure, with mastopexy and lipofilling. The study included patients who underwent a mastopexy plus lipofilling following breast implant removal. The indications for the surgical procedure were: desire of not having breast implants anymore and smaller breasts, capsular contracture, and implant rupture. The surgical procedure is detailed. Fat grafting and mastopexy are done immediately at the time of explantation. A total of 26 patients (mean age 59.1years) underwent mastopexy plus lipofilling following breast implant removal. The mean follow-up was 18months. The mean amount of lipofilling was 258cc. No major complications were observed, no infection, dehiscence, hematoma, or seroma. One patient had an oil cyst which was handled with resection. The auto-augmentation procedure after implant removal with local flaps and lipofilling is the better option for patients in whom breast implants are not an option anymore. Complication and reoperation rates are low and patient satisfaction is good. 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 .

Safety Profiles of Fat Processing Techniques in Autologous Fat Transfer for Breast Reconstruction.

Autologous fat transfer is common in breast reconstruction because of its versatility for use in contour deformities. The authors examined three different fat grafting processing techniques for complications and safety profile using their institutional database. Retrospective review was performed of patients from a single institution who had undergone autologous fat transfer following breast reconstruction from 2012 to 2016. Individuals were separated into three cohorts according to fat harvest technique: (1) centrifugation, (2) Telfa gauze, or (3) Revolve. Complications between the groups were assessed. A total of 267 cases of autologous fat transfer were identified (centrifugation, n = 168; Telfa, n = 44; and Revolve, n = 55). Grafting by means of centrifugation was associated with the greatest incidence of oil cysts (12.5 percent; p = 0.034), postoperative adverse events observed in the clinic (13.7 percent; p = 0.002), and total complications (25.6 percent; p = 0.001). The use of Telfa resulted in the lowest rates of oil cyst formation (0 percent; p = 0.002) and total complications (2.3 percent; p = 0.001). Grafting by means of centrifugation was also associated with the highest frequency of repeated injections among the three techniques after initial grafting (19.6 percent; p = 0.029). In contrast, Revolve demonstrated a repeated injection rate of just 5.45 percent, significantly lower when independently compared with centrifugation (p = 0.011). Multivariate analysis demonstrated that higher total graft volume (p = 0.002) and the use of centrifugation (p = 0.002) were significant risk factors for adverse events seen in the clinic postoperatively. Significant differences in postoperative outcomes exist between varying fat transfer techniques. Autologous fat transfer by means of centrifugation harbored the highest rates of complication, whereas Telfa and Revolve exhibited similar safety profiles. Therapeutic, III.

Abstract P5-16-07: Short-term outcomes and QoL following autologous fat transfer in oncoplastic and reconstructive breast surgery

Abstract Background: Breast cancer (BC) is with 30% among all cancers the most common cancer among women in Austria. Regarding therapy and management of BC, surgical treatments with resection and reconstruction play a crucial role. Breast-conserving therapy (BCT) represents a common procedure. However, mastectomy is still needed in about 30% of the patients with the diagnosis BC and as prophylactic surgery in indicated cases. Recently, autologous fat transfer (AFT, lipofilling) has been used to improve cosmesis in oncoplastic and reconstructive breast surgery. There is a gap of evidence for the oncological safety as well as the benefit for quality of life (QoL) in patients who had an AFT after the BC or prophylactic surgery. Material and methods: We assessed peri-and postoperative results, oncological outcomes and QoL in 55 patients undergoing AFT after BCT or mastectomy at our department between 2013 and 2018. QoL was assessed with the EORTC QLQ C30 and QLQ-BRECON23 questionnaires. Results: Overall, 55 patients (73 breasts) underwent AFT after BCT or mastectomy. 39 patients had a diagnosis of invasive BC (four bilateral) and six patients a diagnosis of DCIS. 24 mastectomies were done as prophylactic surgery. AFT was done in 22 cases with nipple sparing mastectomy (NSM), in 30 cases with skin sparing mastectomy (SSM), in 9 cases with simple mastectomy ± reconstruction and in 12 cases with BCT. The number of AFT sessions was 1-8 (mean 1.8). The injected fat volume per session was 30-390 ml. There were 10 (14%) complications: 3 hematomas (none needed reintervention), local inflammation requiring antibiotic therapy (n=3), formation of an oil cyst (n=1), and fat necrosis (n=3). In two cases of fat necrosis biopsy was performed to confirm the diagnosis. After a median follow-up of 34 months there was one recurrence (Paget´s disease after BC). QoL data will be presented at the meeting. Conclusion: Lipofilling after mastectomy for cancer appears to be oncologically safe. Our complication rate is relatively high, although additional surgical intervention (biopsy) was only necessary in two cases. Patients considering AFT should be informed about additional risk for biopsy, as well as other common complications. Citation Format: Bjelic-Radisic V, Oberfichtner K, Wurzer P, Trapp E, Rappl T, Reisniger J, Kamolz L-P, Tamussino K. Short-term outcomes and QoL following autologous fat transfer in oncoplastic and reconstructive breast surgery [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-07.

Abstract: A Novel Nanofiber-Hydrogel Tissue Scaffold for Improved Fat Graft Survival

INTRODUCTION: Autologous fat grafting is an important adjunct to soft-tissue reconstruction in patients after oncologic resection of tumors. However, it is associated with multiple complications such as fat necrosis, oil cyst formation, and poor volume retention. There currently exist no tissue scaffold materials that aid in human fat graft retention. The purpose of this study is to demonstrate that our novel nanofiber-hydrogel composite serves as a tissue scaffold that improves fat graft retention and promotes enhanced vascularization within the graft. METHODS: The following groups were studied: 100% lipoaspirate, 50% lipoaspirate/50% composite, 50% lipoaspirate/50% hydrogel, 75% lipoaspirate/25% composite, and 100% composite. 500uL of material was subcutaneously injected into both flanks of Foxn1nu NU/J male mice (2 injections per mouse). Fifteen mice were used per group. Mice were imaged using MRI at post-operative day (POD) 2, 28, 56, and 84 to assess graft volume retention. Grafts were explanted on days 7, 28, and 84. Immunohistochemistry (IHC) was performed on explanted grafts to evaluate graft vascularization and adipocyte morphology. RESULTS: The 50% lipoaspirate/50% composite and 75% lipoaspirate/25% composite groups had the highest volume retention on MRI volumetric analysis (38%, 41% respectively) on POD84. The 100% composite only group had the poorest volume retention (14%) on POD 84. On IHC, groups containing the nanofiber-hydrogel composite demonstrated superior rates of angiogenesis and blood vessel ingrowth into the graft as compared to lipoaspirate and lipoaspirate/hydrogel only groups. Furthermore, adipocyte morphology was better preserved in groups containing the nanofiber-hydrogel composite. CONCLUSION: Both groups containing a combination of lipoaspirate/composite exhibited superior volume retention at POD 84 compared to solely lipoaspirate or lipoaspirate/hydrogel combination. Furthermore, the combination of lipoaspirate and composite results in better volume retention compared to either group alone. As demonstrated through IHC, our nanofiber-hydrogel composite promotes higher degrees of angiogenesis than does 100% lipoaspirate or 50% lipoaspirate/50% hydrogel. The nanofiber-hydrogel composite better preserves adipose cell morphology in fat grafting. This has important clinical implications, as improved fat graft retention would save the patient the additional morbidity of undergoing multiple bouts of anesthesia and multiple surgical procedures.

Oil cyst of breast: a rare mammographic finding

Oil cysts of breast are rare benign breast disorders resulting from fat necrosis. Oil cysts are rare mammographic findings encountered. Here, we describe a case of 35 years female with history of breast trauma who presented with a small breast lump which was later diagnosed as oil cyst.

Abstract: Determining the Oncologic Safety of Autologous Fat Grafting as a Reconstructive Modality: an Institutional Review of Breast Cancer Recurrence Rates and Surgical Outcomes

INTRODUCTION: The increasing use of autologous fat grafting (AFG) in breast cancer patients has raised concerns regarding its potential to obscure radiographic monitoring and enhance cancer recurrence. Given the paucity of strong data addressing these concerns, this study evaluates patient outcomes and tumor recurrence following oncologic resection and AFG. MATERIALS AND METHODS: Retrospective chart review identified patients who underwent oncologic resection for breast cancer or carcinoma in situ, followed by breast reconstruction, from 2010 to 2015. 524 patients met inclusion criteria: 148 (28.2%) patients underwent AFG (test group), while 376 (71.7%) patients did not undergo AFG (control group). Patient demographics, cancer characteristics, oncologic treatment, surgical treatment, surgical complications, local recurrence, and distant metastases were analyzed. RESULTS: Both patients who underwent AFG and those who did not were of similar BMI, smoking status, and BRCA status. Patients who underwent AFG were significantly younger (47.6 years vs. 52.1 years, p<0.05), and were less likely to have diabetes (2% vs. 7.2%, p<0.05) than those who did not undergo AFG. In per breast analysis, the two groups demonstrated similar surgical indication rates (therapeutic vs. prophylactic), distribution of Stage 1, 2, and 3 cancer, and similar rates of chemotherapy and radiation. DCIS was more common in the AFG group (20.6% vs. 14.5%, p=0.013), while hormone therapy was less common (52.4% vs. 67.5%, p=0.012). Patients underwent 1 to 4 AFG procedures: 2 in 16.9%, 3 in 3.2%, and 4 in 0.4%. Mean follow-up time from initial surgery was 42.1 months in the AFG group and 34.5 months in the control group (p<0.01). The overall complication rate following AFG was 9.4%; with a 1.7% infection rate, 1.3% fat necrosis rate, 6.0% oil cyst rate, and 0.4% wound healing problem rate. There were no incidences of seroma or hematoma following AFG. Additionally, the AFG and non-AFG groups demonstrated no significant differences in overall reconstructive complication rates (25.2% vs. 23.5%), or individual rates of infection, wound healing complications, hematoma or seroma formation, implant exposure, or flap failure. Among breasts receiving surgery for therapeutic indications (AFG n=162, control n=414), there were similar rates of local recurrence: AFG group 2.5%, control group 1.9% (p=0.688). Interestingly, the mean time to recurrence was significantly longer in the AFG group (52.3 vs. 22.8 months from initial surgery, p=0.02). CONCLUSION: AFG is a powerful tool in breast reconstruction. This large single-institution study, which evaluates patients of comparable BRCA status, cancer staging, chemotherapy, and radiation therapy, provides valuable evidence-based support for its oncologic safety. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial disclosure to report

Ultrastructural characterization of craniopharyngioma at the tumor boundary: A structural comparison with an experimental toxic model using “oil machinery” fluid, with emphasis on Rosenthal fibers

Craniopharyngiomas (CPs) are cystic, encapsulated, slow-growing epithelial tumors. CPs can be aggressive forms invading and resorting surrounding structures of adjacent brain tissue, where Rosenthal fibers (RFs) are expressed. The aim of this study was to investigate the ultrastructure of these fibers in human biopsies and compare it with an experimental toxic model produced by the cortical infusion of the oil cyst fluid (“Oil machinery” fluid or OMF) from CPs to rats. For this purpose, the CPs from ten patients were examined by light and electron microscopy. OMF was administered to rats intracortically. Immunohistochemical detection of glial fibrillary acidic protein (GFAP) and vimentin was assessed. In both freshly obtained CPs and rat brain tissue, the presence of abundant cellular debris, lipid-laden macrophages, reactive gliosis, inflammation and extracellular matrix destruction were seen. Ultrastructural results suggest focal pathological disturbances and an altered microenvironment surrounding the tumor–brain junction, with an enhanced presence of RFs in human tumors. In contrast, in the rat brain different degrees of cellular disorganization with aberrant filament–filament interactions and protein aggregation were seen, although RFs were absent. Our immunohistochemical findings in CPs also revealed an enhanced expression of GFAP and vimentin in RFs at the peripheral, but not at the central (body) level. Through these findings we hypothesize that the continuous OMF release at the CPs boundary may cause tissue alterations, including damaging of the extracellular matrix, and possibly contributing to RFs formation, a condition that was not possible to reproduce in the experimental model. The presence of RFs at the CPs boundary might be considered as a major criterion for the degree of CPs invasiveness to normal tissue. The lack of RFs reactivity in the experimental model reveals that the invasive component of CPs is not present in the OMF, although the fluid per se can exert tissue damage.

Sonographic Features and Diagnostic Analysis of Benign Chronic Inflammatory Breast Lesions in Nonlactating Women.

Sonographic Features and Diagnostic Analysis of Benign Chronic Inflammatory Breast Lesions in Nonlactating Women.

Superficial Enhanced Fluid Fat Injection (SEFFI) to Correct Volume Defects and Skin Aging of the Face and Periocular Region.

Although recent research on micro fat has shown the potential advantages of superficial implantation and high stem cell content, clinical applications thus far have been limited. The authors report their experience with superficial enhanced fluid fat injection (SEFFI) for the correction of volume loss and skin aging of the face in general and in the periocular region. The finer SEFFI preparation (0.5 mL) was injected into the orbicularis in the periorbital and perioral areas, and the 0.8-mL preparation was injected subdermally elsewhere in the face. The records of 98 consecutive patients were reviewed. Average follow-up time was 6 months, and average volume of implanted fat was 20 mL and 51.4 mL for the 0.5-mL and 0.8-mL preparations, respectively. Good or excellent results were achieved for volume restoration and skin improvement in all patients. Complications were minor and included an oil cyst in 3 patients. The smaller SEFFI quantity (0.5 mL) was well suited to correct volume loss in the eyelids, especially the deep upper sulcus and tear trough, whereas the larger SEFFI content was effective for larger volume deficits in other areas of the face, including the brow, temporal fossa, zygomatic-malar region, nasolabial folds, marionette lines, chin, and lips. The fat administered by SEFFI is easily harvested via small side-port cannulae, yielding micro fat that is rich in viable adipocytes and stem cells. Both volumes of fat (0.5 mL and 0.8 mL) were effective for treating age-related lipoatrophy, reducing facial rhytids, and improving skin quality. 4 Therapeutic.

Intracerebral injection of oil cyst content of human craniopharyngioma (oil machinery fluid) as a toxic model in the rat brain

Craniopharyngiomas (CPs) are benign epithelial cystic tumors of the sellar and suprasellar region with a high survival rate and high recurrence in children. CPs contain dense oily fluid, but little is known yet about this content and its contribution to tissue damage and tumoral growth. In this study, we developed a simple experimental model produced by intracortical injection to rats of the cyst fluid content collected from human CPs to explore its possible contribution to brain tissue damage. The cyst fluid of the CPs (“oil machinery fluid”) was collected during surgical removal, briefly preserved and further tested in rats through intracortical infusion. The group receiving “oil machinery fluid” presented increased reactive oxygen species formation, oxidative damage to lipids and reactive gliosis accompanied by augmented immunoreactivity to peroxiredoxin and thioredoxin reductase 1 at 15, 30 and 45 days post-injection. Other markers of inflammation and cell damage were stimulated at all post-lesion days tested. There was also a body weight gain. The persistence of tissue damage and oxidative stress suggests that “oil machinery fluid” exerts progressive alterations similar to those observed in patients with CPs, supporting the concept that some components of cyst fluid may contribute to brain tissue damage in these patients.

Abstract P4-17-09: Efficacy and safety of lipomodelling and adipose tissue derived degenerative stem cells(ADRC) for breast reconstruction – Medium term follow up

Abstract Background: Past and current literature support Lipomodelling as a tool for breast reconstruction. Lipomodelling with Adipose tissue Derived Regenerative Stem Cells dramatically improves the graft survival through both adipogenesis and angiogenesis. Literature regarding safety of this procedure for breast reconstruction is limited. Our aim was to assess the safety and efficacy of ADRC-enriched fat grafts for breast reconstruction. Material &amp; Methods: A prospective study from September 2008 – April 2012 at a District General Hospital UK including patients operated by two breast surgeons. The indications and the fat grafting procedures used are analyzed (Cytori Celution 800/CRS or Cytori pure graft system). Patients with benign indications were followed for 1 year and those with cancer were followed for 5 years according to regional guide lines with breast imaging. Results: Out of total 50 patients, 10 had benign diagnosis while 40 had breast cancer treatment. 30 patients had correction after breast conservation, 17 had revision of reconstruction (8 TRAM, 4 LD and 5 implant based reconstruction) while 3 had other procedures. 19/40 had history of breast irradiation as adjuvant treatment after surgery for breast cancer. Median age was 52 years with range 18–72 years. ADRC enriched fat grafting was done in 40 cases and pure graft in10 patients. Graft volume injected was 80–420 mls (average 247 mls). 90% patients are satisfied with outcome of surgery with good to excellent cosmetic outcome. Only 4 patients had noticeable fat resorption, 3 underwent redo grafting. At average follow up of 21 months (1–48 months) no significant complications were seen, imaging showed fat necrosis in 3 and oil cyst in 1 patient though no one required biopsy. No patient developed local recurrence, although 4 subsequently found to have metastatic disease. Conclusion: We found it a useful, safe and effective technique for breast reconstruction with high patient satisfaction. We recommend a central database of all patients with this procedure to substantiate findings of this study and as recommended by Association of Breast Surgery (ABS) &amp; British Association of Plastic Reconstructive &amp; Aesthetic Surgeons (BAPRAS). Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-17-09.