The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes

Abstract

Background:The fat grafting process includes the 4 phases of tissue harvesting, processing, recipient-site preparation, and reinjection. Among them, the preparation of the recipient site has never been exhaustively reviewed. We aim to provide a comprehensive overview of the methods to prepare the recipient site through external expansion with the resulting outcomes.Methods:PubMed/Medline database was searched for studies on fat grafting recipient site preparation by applying the following algorithm: ((fat grafting) OR (lipofilling) OR (lipograft) AND (recipient site)). A priori criteria were used to review the resulting articles and identify those dealing with external expansion.Results:Fourteen studies published from 2008 through 2016 met inclusion criteria (4 case reports, 6 retrospective, and 4 prospective studies), representing 1,274 treated patients. Two devices for preexpansion were used with different protocols: BRAVA system and Kiwi VAC-6000M with a PalmPump. The 13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeon.Conclusions:External expansion and fat grafting is a promising technique for breast reconstruction and augmentation. However, due to the overall low level of evidence of the available studies, further research is needed to validate the procedure.

Three-dimensional Assessment of the Breast: Validation of a Novel, Simple and Inexpensive Scanning Process

“…In detail, the following results were observed with regard to vector distances: mean L-M distance was equal in the right and left breast for each scanner with the exception of the CT scan, and ranged between 129.56 mm (SD=0.40) measured with Vectra M5 scanner and 130.07 mm (SD=1. 34 19) in the left breast (p=0.39), with no statistically significant difference among the Structure Sensor 3D scanner, Vectra M5 scanner or Artec Eva 3D scanner. However, in this last group, a statistically significant difference was observed with the CT scan images (p=0.0004).…”

“…The application of three-dimensional imaging to breast surgery is a fast-developing concept that has been validated to date by a number of studies for both accuracy and reproducibility of the technology (1-9, 13-18). This has been considered particularly useful for the pre-operative planning and post-operative assessment of operations such as breast reconstruction, breast augmentation and breast reduction, as well as for the assessment of fat grafting outcomes where also small volume variations must be considered (3,(19)(20)(21). Our aim was to validate the use of an innovative and inexpensive scanning process.…”

Long-term impact of lipofilling in hybrid breast reconstruction: retrospective analysis of two cohorts

“…Data were analyzed using SPSS version 22.0 (IBM statistics for Windows version 22, IBM Corporation, Armonk, NY, USA). [13][14][15][16][17][18][19], and replacement with the final prosthesis was performed after a mean of 19 weeks (range 17-25). The mean volume of the definitive prosthesis was 438 cc (range 150-800 cc): although there were no statistically significant differences between groups (p > 0.05), larger volume prostheses were used in group 1 (Fig.…”

“…Even in breast implant augmentation, lipofilling now has a well-recognized role [10,11]. A large number of studies have investigated the technique of fat grafting, its safety in breast surgery, the variations offered by the different types of harvesting techniques, optimal donor site, device employed, elaboration of adipose tissue, recipient site preparation, and timing of surgery [12][13][14][15][16][17][18][19][20]. Many reviews are available comparing dozens of studies, analyzing every step of the lipofilling procedure, in order to find a standard method to ensure the best graft-taking rate [21][22][23].…”

Intraoperative Strategies for Minimal Manipulation of Autologous Adipose Tissue for Cell- and Tissue-Based Therapies: Concise Review

“…Accordingly, increase in engraftment of cSVF has been achieved by promoting hypoxic stress resistance . Different methods to prepare the recipient site have been proposed to further increase the graft retention , as recently reviewed in detail . The following subsections contain a short presentation of the principal methods for obtaining emulsified tSVF.…”