Gentle is better: The original “gentle technique” for fat placement in breast lipofilling

Abstract

Context:Breast lipofilling usually involves three different stages (harvesting, processing, and placement), and in each of these phases, adipocyte cells can be damaged. Our technique of fat placement is quite different from the others as we focus our attention on the last stage of fat graft procedure, which could explain the better results in graft survival.Aims:Our method is focused on eliminating any unnecessary manipulation of the graft so as to optimize graft retention and clinical outcomes: Controlled movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater survival rate of adipocytes.Settings and Design:This was a retrospective cohort study.Materials and Methods:Of 120 patients (average age 41,5 years) affected by breast soft tissue defects, 60 were managed with the lipofilling procedure using fat graft injected by “Gentle technique.” To establish the effects of the injection’s procedure, we compared the results obtained in fat graft maintenance with a control group made up of 60 patients, treated with fat graft injection according to Coleman procedure.Statistical Analysis Used:Values are expressed as mean plus standard error and analyzed using Student’s t test.Results:In patients treated with Gentle technique, we observed a 60.5% + 12.5% maintenance of contour restoring and three-dimensional volume after 1 year (P < 0.0001 vs. control group); we compared the results obtained with only 39% + 4.4% of the control group treated with fat graft injected according to Coleman.Conclusions:Controlled 26 movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater 27 survival rate of adipocytes.

Engineered Fat Graft Enhanced with Adipose-Derived Stromal Vascular Fraction Cells for Regenerative Medicine: Clinical, Histological and Instrumental Evaluation in Breast Reconstruction

“…The donor site region (abdomen) was infiltrated with a cold saline solution containing 1 mL of adrenaline per 500 mL of saline solution without lidocaine or carbocaine to reduce the bleeding during the procedure. An inverse relationship has been observed between the blood amount in the lipoaspirate and the viable number of adipocytes [39]. The adipose tissue was removed after 5 min while using a 3-mm-diameter cannula and a 60-cc Toomey syringe.…”

“…The fat injection was performed while using the "Gentle technique” [39] based on a slow and gentle injection implanting linear deposits of fat graft in the suprafascial, retroglandular and intraglandular space [39,40]. For this reason, the EF-e-A was implanted in multiple tunnels with slow and controlled movements through different entrances (inframammary fold, supero and infero-external quadrant, supero and infero-internal quadrant, periareolar) to underline the importance of a non-traumatic procedure to maximize the integrity of the grafted fat and to maximize the contact surface between the lipoaspirate and the host’s capillaries [38,39]. The diffusion of the nutrients from neighboring capillaries is essential in adipocyte survival and it favors their integration with the surrounding tissue [38,39].…”

“…For this reason, the EF-e-A was implanted in multiple tunnels with slow and controlled movements through different entrances (inframammary fold, supero and infero-external quadrant, supero and infero-internal quadrant, periareolar) to underline the importance of a non-traumatic procedure to maximize the integrity of the grafted fat and to maximize the contact surface between the lipoaspirate and the host’s capillaries [38,39]. The diffusion of the nutrients from neighboring capillaries is essential in adipocyte survival and it favors their integration with the surrounding tissue [38,39]. The incisions were closed with a 5-0 nylon suture and no compressive bandage was applied.…”

Characteristics and Potentiality of Human Adipose-Derived Stem Cells (hASCs) Obtained from Enzymatic Digestion of Fat Graft

“…The fat injection was performed using the “Gentle technique” based on a slow and gentle injection implanting linear deposits of fat graft in the suprafascial, retroglandular e intraglandular space [18]. For this reason, the SVF-enhanced fat graft was implanted in multiple tunnels with slow and controlled movements through different entrances (inframammary fold, supero and infero-external quadrant, supero and infero-internal quadrant, periareolar) to underline the importance of a non-traumatic procedure to maximize the integrity of the grafted fat, and to maximize the contact surface between the lipoaspirate and the host’s capillaries [17,18]. The diffusion of nutrients from neighboring capillaries is essential for adipocyte survival, and favors their integration with the surrounding tissue [17,18].…”

Autologous Mastopexy and Autoaugmention of the Breast

“…Gentle technique of lipofilling has shown statistically higher fat survival percentages. 7 With an increased number of patients refusing silicone implants increased popularity and satisfying cosmetic outcomes of AFG, the search for a technique characterized of being easy, with fewer scars and better aesthetic outcomes with maximal projection and upper pole fullness as an alternative to implants was our goal.…”