Fat Grafting Sessions Research Articles

Combined supraperiosteal microfat grafting and intradermal nanofat for the treatment of periorbital melanosis (dark circles)

Objectives: Dark circles are one of the most common aesthetic concerns in India. While several treatment options exist, none address both volume deficiency and skin quality simultaneously. We felt that fat grafting and nanofat provided a novel treatment option to address both aspects of dark circles in one treatment. Material and Methods: Patient records were examined from 2017 to 2021. A total of 28 patients were identified as having undergone fat grafting and nanofat for dark circles specifically. The patients were analyzed for age, gender, volumes injected, and outcomes based on patient self-assessment. Results: A total of 36 patients underwent fat grafting ranging from the age of 20 to 40 (average 31). All procedures were done under local anesthesia as day care procedures. The volumes injected range from 2 cc/side to 8 cc/side, with an average of 4.36 cc. Using the Likert scale, 28 (77%) rated their results as very satisfied. Six (17%) rated it as satisfied. One rated it as neutral and two rated it as average, and underwent a second session of fat grafting where another 2 cc was injected per side. Conclusion: Fat grafting and nanofat are an exciting treatment option for the treatment of dark circles, which is usually regarded as a recalcitrant problem. It has the advantages of addressing both volume and skin quality, being a single-stage procedure, and producing comparatively long-lasting results.

Fat Grafting and Prepectoral Prosthetic Reconstruction with Polyurethane-Covered Implants: Protective Role against Adjuvant Radiotherapy.

Background/Objectives: Breast cancer treatment increasingly incorporates immediate prepectoral prosthetic reconstruction after conservative mastectomy, including nipple-sparing (NSMs) and skin-sparing mastectomies (SSMs). Although recent data from the literature show that postmastectomy radiotherapy (PMRT) after prepectoral reconstruction presents good clinical results, with reduction in capsular contracture and implant migration, compared to the traditional submuscular technique, these patients have higher rates of long-term complications when compared with nonradiated patients. This study evaluates the protective effects of autologous fat grafting to reduce long-term radiotherapy-induced complications in breast cancer patients submitted for prepectoral reconstruction with polyurethane-covered (PU) implants. Methods: A pilot study with two parallel cohorts of patients undergoing an NSM or SSM followed by PMRT was conducted. Patients were randomly assigned to either of the two groups to ensure homogeneity. One cohort underwent autologous fat grafting sessions, individually tailored based on periodic evaluations by the principal investigator (PI), M. Salgarello, at least six months after PMRT. The control group received standard clinical follow-ups without fat grafting. Inclusion criteria ensured participants were disease-free, non-smokers, and had a LENT-SOMA score within 2. Results: Preliminary findings indicate significant differences between the groups, with improved outcomes observed in patients undergoing tailored lipofilling. Specifically, these patients experienced a notable reduction in capsular contracture severity and reported higher satisfaction with the aesthetic results compared to the control group. Conclusions: Autologous fat grafting, customized per patient by the PI based on ongoing evaluations, appears to mitigate some adverse effects of radiotherapy in prepectoral breast reconstruction, suggesting a viable option for enhancing surgical outcomes in irradiated patients. Further research is needed to substantiate these findings and evaluate long-term benefits.

Efficacy of Exclusive Fat Grafting for Breast Reconstruction: An Updated Systematic Review and Meta-analysis.

Exclusive fat grafting is an alternative method to implant- or flap- based reconstruction techniques following mastectomies or breast conservation therapies. Its efficacy has been explored before but new data has come to light, resulting in previous results becoming outdated. Concerns have also been raised about the oncological safety of this procedure which must be evaluated alongside the efficacy to gain a comprehensive understanding of the merits of this alternative technique. We queried the PubMed electronic database from its inception until August 2023 for studies evaluating the efficacy and oncological safety of exclusive fat grafting breast reconstruction following cancer-related mastectomy or breast conservation therapy. Results of the analysis were pooled and presented as means or valid proportions. Results of the analysis were pooled using a random-effects model and presented with 95% confidence intervals (95% CIs) where appropriate. 41 studies were included in our analysis. Pooled results show that on average, 1.7 sessions of exclusive fat grafting were required to complete reconstruction in Breast Conservation Therapy (BCT) patients, with an average volume of 114.2 ml being injected. For mastectomy patients with irradiated breasts, 4.7 sessions were needed on average with 556.8 ml being required to complete reconstruction, compared to their non-irradiated Counterparts requiring only 2.6 sessions and 207.2 ml to complete reconstruction. Oncological recurrence events were found in 29/583 non-irradiated mastectomy patients (p = 0.014) and in 41/517 BCT patients (p = 0.301) CONCLUSION: Exclusive fat grafting is an oncologically safe and reasonably efficacious alternative to more common methods of breast reconstruction. More data is needed to fully characterize the oncological safety of this procedure in irradiated and non-irradiated mastectomy patients. 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 .

LA GREFFE DES CELLULES ADIPEUSES DANS LESTHETIQUE DE LA FACE: TECHNIQUE ET INDICATIONS

The objective of our study is to highlight the technique, the different indications, and the results of autologous fat grafting in facial aesthetics by reporting the experience of our department and through a literature review. This is a retrospective study involving 14 patients who underwent aesthetic and reparative facial fat grafting over a period of 2 years, from January 1, 2022, to January 1, 2024, at the Department of Plastic, Reconstructive, Aesthetic, and Burn Surgery of the Mohammed VI University Hospital Center in Marrakech. We collected 22 autologous facial fat grafts, with the mean age of our patients being 26.36 years, ranging from 11 to 58 years. A clear female predominance was noted (86.4%) with a female-to-male ratio of 6. The two main indications were atrophy and volume enhancement (72%) and contour refinement (28%). The procedures were performed under general anesthesia. The fat was harvested from a single donor site: the abdominal region. The mean volume harvested was 96.8 ml, ranging from 80 ml to 120 ml. All samples were centrifuged at a speed of 3,000 rpm for 3 minutes. The mean injected volume was 25.55 ml, ranging from 5 to 90 ml. 10% of the fat grafts were associated with a facelift. The average length of hospital stay was 1 day. None of our patients experienced immediate or late complications. 68% of patients underwent a single fat grafting session, 21% underwent 2 sessions, and only 11% required 3 sessions. The mean interval between sessions was 3 months. Subjective evaluation of satisfaction 3 months after the last intervention revealed a satisfaction rate of 90%. Adipose cell grafting is currently considered an ideal method for facial rejuvenation and reshaping due to its safety, simplicity, reproducibility, and the durable and natural results it achieves.

Technical Refinements and Outcomes Assessment in Prepectoral Pocket Conversion After Postmastectomy Radiotherapy.

Several studies show how submuscular breast reconstruction is linked to animation deformity, shoulder dysfunction, and increased postoperative chest pain, when compared to prepectoral breast reconstruction. In solving all these life-impairing side effects, prepectoral implant pocket conversion has shown encouraging results. The aim of this study was to propose a refinement of the prepectoral implant pocket conversion applied to previously irradiated patients. We conducted a retrospective study on 42 patients who underwent previous nipple- or skin-sparing mastectomy and immediate submuscular reconstruction, followed by radiotherapy. We performed fat grafting sessions as regenerative pretreatment. Six months after the last fat graft, we performed the conversion, with prepectoral placement of micropolyurethane foam-coated implants. We investigated the preconversion and postconversion differences in upper limb range of motion, Upper Extremity Functional Index, and patient satisfaction with the breast and physical well-being of the chest. We reported a resolution of animation deformity in 100% of cases. The range of motion and the Upper Extremity Functional Index scores were statistically improved after prepectoral implant pocket conversion. BREAST-Q scores for satisfaction with the breast and physical well-being of the chest were also improved. The refined prepectoral implant pocket conversion is a reliable technique for solving animation deformity and improving quality of life in patients previously treated with submuscular reconstruction and radiotherapy.

1142 Using Lipofilling to Improve Skin Quality Following Severe Radiation Necrosis to Enable Successful Joint Replacement – a Case Report and Literature Review

Abstract Case A 74-year-old female patient presented with severe osteoarthritis and pathological fracture of the left knee, following treatment with radiotherapy of osteosarcoma over a decade ago. Surgical management of the fracture was initially not possible, due to radiation-induced fibrosis of the skin. She was referred to the plastic surgery department where she underwent a total of three sessions of fat grafting over nine months. The rigotomy approach was applied to the large area of irradiated skin. As a result, her skin quality improved such that a successful total knee replacement was possible. The outcome of this was better mobility and improved quality of life. Conclusions Skin quality after radiotherapy can limit surgical options, even decades after treatment. Fat grafting, also known as lipofilling, is a commonly utilised reconstructive and cosmetic adjunct. However, recent reports of its effect on skin quality are gaining popularity. We present a case of successful use of fat transfer to improve irradiated skin quality prior to successful joint replacement; this is a novel use case which we believe to be the first published.

Patient Outcomes after Fat Grafting to the Radiated Chest Wall before Delayed Two-stage Alloplastic Breast Reconstruction

Background: Two-stage alloplastic breast reconstruction in patients having received mastectomy and radiation is associated with a high rate of complications. Fat grafting has been shown to mitigate the effects of radiation on the chest wall to allow for alloplastic reconstruction. In this study, we assess the outcomes (after a mean follow-up of 28 months), including complications and revisional procedures, of women who had fat grafting to the radiated chest wall before two-stage implant-based breast reconstruction. Methods: A retrospective chart review was performed on consecutive patients seeking delayed implant-based reconstruction after simple mastectomy and postmastectomy radiation therapy between 2011 and 2015. All patients underwent two sessions of fat grafting to the radiated chest wall before inserting a tissue expander and subsequent exchange to a silicone implant. Results: Twenty patients were included in the study. No reconstructive failures were recorded. The short-term complication rate was 5%, with one hematoma leading to a revisional procedure. The mean follow-up after reconstruction was 28 months. During follow-up, two patients (10%) developed capsular contracture grade IV with implant malposition, leading to capsular revision and implant exchange. Four patients (20%) underwent additional fat grafting for contour deformities. Conclusions: Fat grafting before two-stage alloplastic breast reconstruction in patients treated with mastectomy and postmastectomy radiation therapy may provide an alternate method of alloplastic reconstruction in a select group of patients who are not suitable for autogenous reconstruction. Follow-up data show that additional surgery may be required for correction of implant malposition and capsular contracture.

Treating Pain and Fat Necrosis after Breast Cancer Surgery with Fat Grafting: Is one Session Enough?

Chronic pain after breast cancer surgery is affecting up to 60% of patients, causing significant morbidity to patients. Lately, fat grafting has been applied as a therapy for chronic neuropathic pain. We report a series of eighteen patients, who were treated for pain after breast cancer surgery. Twelve patients had a breast conserving therapy, two a mastectomy and four an autologous flap-based reconstruction. While most presented with neuropathic pain, six patients had fat necrosis in their history. Most patients presented with severe pain (77%) and were treated with fat grafting sessions, performed by water-assisted liposuction. All patients responded to the interventions; the median number of fat grafting sessions was 2, the median duration of the interventions was 4 months, and the median follow-up period was 56.5 months. The median pain prior to the fat grafting procedure had an intensity of 8 (range 7-9) numeric rating scale points; after the first intervention, this was reduced to 4 (range 2.3-5.8); and after the second intervention, it was down to 2 (range 0.8-3.3). Patients with pain intensities of 4-5 had a good chance of achieving analgesia after one session. Fat grafting could be a new treatment modality for symptomatic fat necrosis: complete or partial suction of the necrosis and/or fat grafting around the necrosis to reduce inflammation and pain. Fat grafting proved a valuable tool, reducing pain or even achieving analgesia after breast cancer surgery presenting with a highly favorable risk-benefit ratio. 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.

One-Stage Mastopexy-Lipofilling after Implant Removal in Cosmetic Breast Surgery.

Revising unsatisfactory outcomes in breast augmentation represents one of the most challenging procedures in aesthetic breast surgery. Different techniques for revising unsatisfactory outcomes in breast augmentation have been described, which can be summarized in two options: implant replacement procedures and implant explantation procedures. Implant explantation procedures can be performed alone or in combination with other techniques to restore volume. Depending on the native volume, the shape and the elasticity of the remaining breast tissue, implant removal can be also associated with mastopexy, auto-augmentation mammoplasty or fat graft. This article portrays our series of combined mastopexy and lipofilling after implant explantation for revising unsatisfactory outcomes of breast augmentation. A prospective observational study was performed including all patients underwent cosmetic one-stage mastopexy-lipofilling after implant removal. Collected data included patient's age and BMI, smoking, previous scar location (periareolar, inframammary fold or trans-axillary), implant characteristics (size and location), reason why patient wants to remove the implant (capsular contracture, implant rupture, animation deformity, chronic pain, asymmetry), mean liposuction and fat injection volume, type of capsulectomy, mean operating time and postoperative complications. Cosmetic results and patient satisfaction were evaluated using the 5 points Likert scale and BreastQ reduction/mastopexy module, respectively. A total of 14 patients (28 breasts) were included with a mean follow-up of 11.3 months. Mean liposuction and injection volumes were 980 mL and 295 mL, respectively. Regarding breast volume, a reduction in one-cup size was noted in 100% of cases. Only one patient (7.69%) requested additional breast volume and underwent a second fat grafting session. Regarding aesthetic outcomes, the mean scores for breast volume, shape, symmetry, quality of scars, nipple-areola complex and donor site shape were 4.2, 4.2, 4.9, 4, 4.3 and 4.7, respectively. BreastQ showed an improvement of patients reported satisfaction with a median (Quartile Rank) score increase of 19 points for the "satisfaction with breast" domain (p < .00001) and a decrease of 17 points for the "physical well-being" domain (p < .00001). "Satisfaction with outcomes" median (Quartile Rank) score was 72. Combined mastopexy and lipofilling after implant removal represents a new tool in plastic surgeon armamentarium. This technique is indicated in patients who do not desire anymore breast implant, presenting ptosis of the remaining breast gland and donor site availability. Our article suggested that combined mastopexy and lipofilling achieves satisfactory aesthetic results and excellent patient-reported outcomes. 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 .

Fat Grafting before Delayed Prophylactic Mastectomy and Immediate Implant Reconstruction for Patients at High Risk of Complications.

The majority of patients undergoing bilateral prophylactic mastectomy request immediate implant-based breast reconstruction. Some patients, especially those with prior radiotherapy, are at increased risk of early cutaneous complications and implant loss. The authors developed the technique of primary fat grafting before delayed prophylactic mastectomy to minimize early complications for selective high-risk patients. They have completed 21 cases in 14 patients, 10 of whom had previous lumpectomy and radiation treatment for breast cancer. A single session of fat grafting, with a median injection volume of 250 ml (interquartile range, 200 to 300 ml), was performed a median period of 19 weeks (interquartile range, 16 to 28 weeks) before prophylactic mastectomy. All cases were direct-to-implant reconstruction using textured silicone implants. The median implant volume was 410 ml (interquartile range, 318 to 450 ml). A minor early complication developed in 14 percent of cases (three of 21), with no early implant loss. At a median follow-up of 9 months (interquartile range, 5 to 27 months), the authors found no cases of implant loss and an excellent or good aesthetic outcome (score of 5 or 4) in 16 of 21 cases (76 percent). Fat grafting before prophylactic mastectomy is a novel strategy to minimize early complications and avoid implant loss in patients at high risk of postoperative complications. . Therapeutic, IV.

Oncological Safety of Autologous Fat Grafting in Breast Reconstruction after Mastectomy for cancer: A case-control study

The use of autologous fat grafting in the context of breast reconstruction is still a matter of controversy. The objective of this study was to compare the local relapse rate in women who had a fat grafting session in the context of breast reconstruction after breast cancer management, to those who had breast reconstruction without fat grafting. We performed a retrospective, monocentric, case-control study from January 2007 to December 2017 in our hospital. The cases included women who underwent breast reconstruction with autologous fat grafting and controls, undergoing breast reconstruction without fat grafting. We compared survival and local recurrence between the two groups. 412 women were included: 109 (26.5%) in the lipofilling group and 303 women (73.5%) in the "no lipofilling" group. In the overall study population, lipofilling did not appear to be a predictive factor for recurrence, HR=1.39 [0.63 - 3.06], p=0.41; or a predictive factor for overall survival, HR=0.84 [0.23 - 3.02], p=0.79, or for distant metastases, HR=1.10 [0.43 - 2.79], p=0.84. In contrast, in the subgroup of women treated for invasive cancer, the multivariate analysis showed that lipofilling in this context was an independent predictive factor for local recurrence (HR= 5.06 [1.97- 10.6], p=0.04). we found an increased risk of local recurrence after lipofilling in women who were managed for invasive breast cancer. This suggests that special consideration should be given to women who have had invasive breast cancer before lipofilling.

Oncologic Safety of Autologous Fat Grafting after Breast Cancer Surgical Treatment: A Matched Cohort Study.

Autologous fat grafting has been an increasingly popular procedure for remodeling the breast of patients undergoing breast cancer surgery. This study's objective was to investigate whether autologous fat grafting is associated with a higher risk of disease recurrence in the context of late breast reconstruction for patients diagnosed with breast cancer who have undergone either breast-conserving surgery or mastectomy. A retrospective matched cohort study was performed in a single tertiary health care center. Data were collected from 42 patients formerly treated for breast cancer who underwent the first session of autologous fat grafting between August of 2007 and June of 2016. A total of 126 patients with similar features, who did not undergo autologous fat grafting, were individually matched at a 1:3 ratio with the autologous fat grafting group. The primary endpoint was locoregional recurrence. Secondary outcomes were rates of local and distant recurrences, disease-free survival, and overall survival. At a mean follow-up of 65 months after fat grafting, no significant differences were found between the lipofilling and control groups for locoregional recurrence (7.1 percent versus 6.3 percent; p = 0.856), local recurrence (7.1 percent versus 5.6 percent; p = 0.705), distant recurrence (14.3 percent versus 7.9 percent; p = 0.238), disease-free survival (21.4 percent versus 19.0 percent; p = 0.837), and overall survival (14.3 percent versus 7.1 percent; p = 0.181). No evidence of increased risk in any of the survival outcomes was identified. Lipofilling seems to be a safe procedure for breast reconstruction after surgical treatment of breast cancer. Therapeutic, III.

New Trends In Treacher Collins Syndrome: Bony Reconstruction And Regenerative Therapy

Aim:Treacher Collins syndrome is a rare congenital disorder of craniofacial development with a highly variable pheonotype. This syndrome occurs with an incidence of 1:50,000, and more than 60% of the cases have no previous family history and arise as the result of de novo mutations. The disorder displays an intricate underlying dysmorphology. Affected patients may suffer life-threatening airway complications and functional difficulties involving sight, hearing, speech, and feeding. Deformation of facial structures produces a characteristic appearance that includes malar-zygomatic hypoplasia, periorbital soft tissue anomalies, maxillomandibular hypoplasia, and ear anomalies. Management requires a specialized craniofacial team, as comprehensive care starts at birth and may require life-long follow-up. Standard craniofacial procedures for bony and soft tissue reconstruction are used. This article outlines current treatment strategies and future concepts for surgical and regenerative management. Methods:The new field of regenerative medicine and therapy offers the promise to improve some of these treatments. In particular, Structural Fat Grafting (lipostructure) seems to be a good strategy to restore the normal volume and contour of the face, and to provide a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. In this work, we present the case of a young girl with Treacher Collins Syndrome who underwent serial sessions of fat grafting in addition to other surgical bony reconstructive techniques. ADSCs have been isolated from the patient’s lipoaspirate, and compared for their stemness properties with those of a healthy subject. Conclusion:Screening of the genome of the Treacher Collins patient using array-Comparative Genomic Hybridization (array-CGH) allowed us to identify some chromosomal imbalances that are probably associated with the syndrome.Correction of these imbalances and asymmetries by modulating ADSCs could be an innovative approach to improve and stabilize the results of the surgical treatment of Treacher Collin Syndrome.

Fat Grafting and Auto-Augmentation Mastopexy After Breast Implant Removal: Technique and Evaluation of Outcomes Using BREAST-Q.

Auto-augmentation mastopexy after implant removal has been described as a possible alternative for women who do not opt for implant replacement and decline major reconstructive surgery. This study aimed to evaluate patient satisfaction after auto-augmentation mastopexy relative to the final breast volume and to assess the role of fat grafting on patients' satisfaction and quality of life according to the BREAST-Q questionnaire. Forty-seven breasts from 28 patients who underwent implant removal and auto-augmentation mastopexy were reviewed; 9 patients (group 1) were primarily treated with several fat grafting sessions with subsequent auto-augmentation, 5 (group 2) were treated primarily with auto-augmentation, but subsequently expressed a wish for breast augmentation by lipofilling, and 14 patients (group 3, control) had only auto-augmentation. Group 1 patients maintained their breast volume, and showed significant improvements in breast satisfaction, psychosocial well-being, and contentment with breast surgery outcomes (P = 0.01, ˂0.01, and ˂0.01, respectively). However, the physical well-being of this group, as well as response to final cup size or interaction parameters, did not improve (P = 0.06). In group 2, all except 1 patient had breast volume reduction to A cup, as was the case with one-third of the patients in control group 3 (group 3A, n = 5) who scored lower, and thus were less satisfied with the breast auto-augmentation than group 3B, who achieved final bigger cup sizes (P ˂ 0.01). Auto-augmentation mastopexy resulted in substantial improvements in the parameters measured by BREAST-Q. Thus, combined auto-augmentation mastopexy and lipofilling provided a better alternative treatment after breast implant removal.

Breast Reconstruction Using a Three-Dimensional Absorbable Mesh Scaffold and Autologous Fat Grafting: A Composite Strategy Based on Tissue-Engineering Principles.

Breast reconstruction remains an important field in plastic surgery, with most procedures using implants and/or autologous tissue. Few series report on experience with fat grafting as the primary form of breast reconstruction. The present article describes a new method of breast reconstruction using a three-dimensional absorbable mesh construct-or Lotus scaffold-and autologous fat grafting. A retrospective review was performed for all patients who underwent breast reconstruction using the Lotus scaffold and autologous fat grafting. Postoperative mammograms and magnetic resonance imaging scans were analyzed. Tissue specimens collected at subsequent procedures were harvested and stained with hematoxylin and eosin for histologic evaluation. Lastly, compression testing of the scaffold was performed using a tensiometer and digital tracking technology. Twenty-two patients underwent reconstruction of 28 breasts using the Lotus scaffold and autologous fat grafting between February of 2015 and February of 2018. Average follow-up was 19 months. All patients were satisfied with final breast shape and size. Mean patient age was 60.5 years and the average body mass index was 28 kg/m. Patients required on average two fat grafting sessions to achieve a successful result (range, zero to four). Postoperative mammography and magnetic resonance imaging showed robust adipose tissue in the breast with a slowly resorbing mesh and no oil cysts or calcifications. Histologic evaluation showed the presence of fat tissue around the scaffold and no evidence of capsule formation. Compression testing revealed the Lotus scaffold to be compliant with a high-resilience profile. The Lotus scaffold with autologous fat grafting is a viable method for breast reconstruction, giving the patient an autologous reconstruction with less morbidity compared to free tissue transfer. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

The role of reconstructive surgery after soft tissue sarcoma resection

Soft tissue sarcomas are rare malignant tumors with pejorative prognosis. They require a multidisciplinary approach in a specialized hospital belonging to the NetSarc network in France. In all cases treated with curative intent, the objective of excision surgery is to achieve wide, microscopically negative margins (R0 according to the UICC classification). When growing on a limb, sarcomas may threaten functionally relevant structures and even lead to amputation. Nowadays, when combined with radiation therapy, wide exeresis limb-sparing surgery is achievable in 90 to 95% of the cases, of which 25% will nevertheless require reconstructive surgery to preserve the limb, to limit postoperative complications and to manage possible sequelae. Progress in reparative surgery, particularly in microsurgery, has helped not only to improve limb salvage rates but also to create wider margins without altering oncologic goals of curative resection. After determining the range of resection, reconstructive surgery should be tailored to address the tissue defect. The converse is to be strongly discouraged. The extent of resection must not be compromised or reduced in order to facilitate reconstructive surgery. A plastic surgeon must master all the flap techniques, including microsurgery, while taking into account the impact of preoperative and postoperative radiation therapy on previously irradiated tissues or on wounds requiring adjuvant therapy. Recent developments, especially as regards perforator flaps, have helped to enhanced the quality of reconstruction procedure while reducing donor site morbidity. In our experience, perforator flaps are a workhorse in reconstructive surgeries subsequent to soft tissue sarcoma of the extremities. On a parallel track, lipofilling (otherwise known as fat grafting or fat transfer) has become the first-line treatment for patients with post-surgical functional or cosmetic sequalae. It is performed after long-term follow-up during disease-free survival. Strict clinical examination and MRI are mandatory prior to programming any local procedure. Usually, three to four sessions of fat grafting are needed to enhance local trophicity or the cosmetic aspect. Sequalae treatments are of great interest in terms of psychological as well as functional outcome.

Safety of Large-Volume Immediate Fat Grafting for Latissimus Dorsi-Only Breast Reconstruction: Results and Related Complications in 95 Consecutive Cases.

Breast reconstruction with implants has proven serious complications, mostly in patients who have undergone radiotherapy. In these cases, autologous reconstruction is the technique of choice. To study if breast reconstruction using latissimus dorsi and immediate fat grafting (LIFG) is a widely applicable technique for those cases in which an autologous reconstruction is desirable, but the use of microsurgical perforator flaps is not available. Data of 95 consecutive breast reconstructions from May 2014 to December 2018 were prospectively collected. All patients included in the study had a minimum follow-up of one year after completion of the reconstructive process. The mean age of the patients was 48.57years with an average follow-up of 20.65months. The mean number of surgeries per patient was 1.61. In 47.4% of the cases, only LIFG surgery was required to accomplish the reconstructive process. The mean volume of fat graft used was 416.00 ± 145.79cc. Relevant statistically significant differences in the volume of graft were found regarding the use of previous radiotherapy and the timing of reconstruction. Radiological fat necrosis nodes were the main complication (15.8%). However, their presence was significantly lower if no additional fat grafting sessions were necessary, though, unexpectedly, no relation was found in relation to the total amount of fat graft needed. LIFG has proved to be a safe and reliable method for total autologous breast reconstruction. Even when a medium to large size is required, a large volume of fat graft is accepted; thus, excellent results can be obtained. It is an interesting alternative for breast reconstruction, in addition to abdominal perforator flaps. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 Surgery.

Autologous Fat Grafting for the Oral and Digital Complications of Systemic Sclerosis: Results of a Prospective Study.

Systemic sclerosis is a connective tissue disease. Skin involvement of the mouth and hand may compromise function and quality of life. Autologous fat grafting has been described as a specific treatment of these clinical features. We report the results of our prospective study designed to treat and prevent skin complications in systemic sclerosis. We treated 25 patients with mouth and/or hand involvement (microstomia, xerostomia, skin sclerosis, Raynaud's phenomenon and long-lasting digital ulcers) with autologous fat grafting, according to the Coleman's technique, around the mouth and/or at the base of each finger. The surgical procedures were repeated in each patient every 6months for a total of two or three times. Clinical data were collected before the first surgery and again 6months after each surgical procedure. Pain, skin thickness, saliva production and disability were assessed with validated tests. Overall we performed 63 autologous fat grafting sessions (either on the mouth, on the hands or on both anatomical areas). Results at 6moths after the last session included improvement of xerostomia evaluated with a sialogram, reduction of the skin tension around the mouth and, in the hands, reduction of the Raynaud phenomenon as well as skin thickness. Pain was reduced while the perception of disability improved. Digital ulcers healed completely in 8/9 patients. Our results confirm the efficacy and safety of autologous fat grafting for the treatment of skin complications and digital ulcers due to systemic sclerosis. In addition, the patients' subjective well-being improved. Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Prepectoral, Hybrid Breast Reconstruction: The Synergy of Lipofilling and Breast Implants.

A single surgeon's experience with the ergonomic, hybrid approach in primary and secondary breast reconstructions is presented. The hybrid approach is based on tissue expansion followed by serial sessions of fat grafting to augment the residual autologous (subcutaneous) compartment. The last step included the insertion of a prepectoral, ergonomic implant to obtain central core projection and additional volume. Fifty-six hybrid breast reconstructions were performed with a mean follow-up of 24.1 months. Aesthetic outcomes and patient satisfaction have been good with pleasing breast projection, natural breast motion, and optimal coverage of the prepectoral implants. The hybrid reconstructive approach is a reliable technique to improve the outcomes in implant-based breast reconstructions. The 2-step, prepectoral approach with expander-to-implant exchange allows better control of the final breast shape, and complications related to submuscular approaches are avoided. Fat grafting adds an autologous benefit to obtain natural results.

Breast Reconstruction Using a 3-dimensional Absorbable Mesh Scaffold and Autologous Fat Grafting: A Composite Strategy Using Tissue Engineering Principles

BACKGROUND: Breast reconstruction remains an important field in plastic surgery, with most procedures utilizing implants and/or autologous tissue. Few series report on experience with fat grafting as the primary form of breast reconstruction. This study reports a novel method of breast reconstruction using a 3-dimensional absorbable mesh scaffold and subsequent autologous fat grafting (AFG). METHODS: A retrospective review was performed for all patients who underwent breast reconstruction using Lotus scaffold and AFG. Postoperative mammogram and magnetic resonance imaging were analyzed, and tissue specimens collected at subsequent procedures were harvested and stained with H&E for histologic evaluation. Finally, compression testing of the scaffold was performed using a tensiometer and digital tracking technology. RESULTS: Twenty-two patients underwent reconstruction of 28 breasts using Lotus scaffold and AFG between February 2015 and February 2018. Average follow-up was 19 months. All patients were satisfied with final breast shape and size. Mean patient age was 60.5 years, and average body mass index was 28. Patients required on average 2 fat grafting sessions to achieve a successful result (range, 1–4). Postoperative mammogram and magnetic resonance imaging revealed robust adipose tissue in the breast with a slowly resorbing mesh and no oil cysts or calcifications. Histologic evaluated revealed no capsule formation with ingrowth of fat tissue around the scaffold. Compression testing revealed that the Lotus scaffold is a compliant construct with a high resilience profile. CONCLUSIONS: The Lotus scaffold with AFG is a viable method for breast reconstruction, giving the patient an autologous reconstruction with less morbidity than free tissue transfer.