Fat Grafting with Tissue Liquefaction Technology as an Adjunct to Breast Reconstruction

Abstract

BackgroundTissue liquefaction technology (TLT) delivers warmed saline from the liposuction cannula tip at low pressure pulses to disaggregate adipocytes. This technology differs significantly from that used in other liposuction devices including water jet-assisted liposuction. Here we introduce our early experience with this technology in the setting of fat transfer for revision breast reconstruction.MethodsA retrospective chart review of 136 consecutive patients who underwent fat harvest with TLT and subsequent transfer into 237 breast reconstructions was conducted at a single institution. This two-surgeon series examined donor and recipient site complication rates over a median follow-up of 143 days [87–233].ResultsThe overall complication rate was 28.7 %, of which the majority (22.1 %) was fat necrosis at the recipient site as documented by any clinical, imaging, or pathologic evidence. The abdomen served as the donor site for half of the cases. Donor site complications were limited to widespread ecchymosis of the donor site notable in 10.4 % of cases. Twenty-five percent of patients had received postmastectomy radiotherapy prior to fat transfer. Prior to revision with fat transfer, implant-based breast reconstruction was used in 75.5 % of cases, and autologous flaps in the remainder. Fat transfer was combined with other reconstructive procedures 94.1 % of the time.ConclusionsTLT can be used to harvest adipocytes for fat transfer with donor site morbidity and recipient site complications comparable to other modalities. The efficiency and quality of harvested fat makes this technology appealing for wide spread adoption during fat transfer.Level of Evidence IVThis journal requires that the 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.

A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer

“…However, fat grafting has become increasingly popular as studies have suggested that fat grafting to the irradiated chest during implant-based reconstruction has notable benefits. 38,39 Sultan et al and Garza et al reported that fat grafting attenuates undesirable results from radiation fibrosis. 40,41 Additionally, fat grafting has been shown to smooth out the contours around an implant, improving overall aesthetics.…”

Ultrasound-assisted liposuction provides a source for functional adipose-derived stromal cells

“…Recently invented techniques such as the Tissue Liquefaction Technology (TLT) liposuction, that uses warm saline and low pressure for adipocyte harvesting, may have shown to reduce donor side morbidity, however, the regenerative potential of ASCs harvested via this approach still remains uncertain [24]. In addition to harvesting methods there are multiple other factors influencing the regenerative efficacy of ASCs, some known such as shear stress [25] and lidocaine exposure [26], and some yet to be determined.…”

Human Adipose-Derived Mesenchymal Stem Cell-Secreted CXCL1 and CXCL8 Facilitate Breast Tumor Growth By Promoting Angiogenesis

“…With the overall survival rates increasing, more and more patients select breast reconstruction as a way to reduce the disabling effects of the mutilation . Autologous fat graft has been used as a filler for breast reconstruction in breast cancer patients following conservative surgery . That is partly because the ADSCs in adipose tissues (about 10 5 ADSCs per gram adipose tissue) can secrete numerous cytokines to benefit the proliferation and angiogenesis of the graft which make it a better graft than other materials .…”