Trends in Autologous Fat Grafting to the Breast

Kling, Russell E.; Mehrara, Babak J.; Pusic, Andrea L.; Young, V. Leroy; Hume, Keith M.; Crotty, Catherine A; Rubin, J. Peter

doi:10.1097/prs.0b013e318290fad1

Cited by 160 publications

(59 citation statements)

References 33 publications

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“…10,20,38,41,46–54 national consensus survey concluded that of the plastic surgeons that perform fat grafting, 34 percent used centrifugation, 45 percent used gravity separation, 34 percent used filtration, 11 percent used gauze rolling, 3 percent did not process the tissue before engraftment, and 7 percent performed some other techniques not specified. 1 Identification of an optimal processing method will increase the number of viable cells and ultimately increase fat engraftment and retention over time.…”

Section: Processing Methodsmentioning

confidence: 99%

“…A recent survey showed that approximately 80 percent of plastic surgeons have used fat grafting in their practice. 1 Fat grafting has been used for facial contouring, breast augmentation, radiation damage, breast capsular contracture, posttraumatic deformities, congenital anomalies, and burn injuries. 2–8 Autologous fat grafts have several beneficial characteristics, including lack of immunogenicity, simple surgical procedure, low cost, and easy accessibility.…”

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confidence: 99%

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The Current State of Fat Grafting

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Cederna

Rubin

et al. 2015

Plastic and Reconstructive Surgery

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Background Interest in and acceptance of autologous fat grafting for use in contour abnormalities, breast reconstruction, and cosmetic procedures have increased. However, there are many procedural variations that alter the effectiveness of the procedure and may account for the unpredictable resorption rates observed. Methods The authors highlighted studies investigating the effects of harvesting procedures, processing techniques, and reinjection methods on the survival of fat grafts. This review focused on the impact different techniques have on outcomes observed in the following: in vitro analyses, in vivo animal experiments, and human studies. Results This systemic review revealed the current state of the literature. There was no significant difference in the outcomes of grafted fat obtained from different donor sites, different donor-site preparations, harvest technique, fat harvesting cannula size, or centrifugation speed, when tumescent solution was used. Gauze rolling was found to enhance the volume of grafted fat, and no significant difference in retention was observed following centrifugation, filtration, or sedimentation in animal experiments. In contrast, clinical studies in patients found more favorable outcomes with fat processed by centrifugation compared with sedimentation. In addition, higher retention was observed with slower reinjection speed and when introduced into less mobile areas. Conclusions There has been a substantial increase in research interest to identify methodologies for optimizing fat graft survival. Despite some differences in harvest and implantation technique in the laboratory, these findings have not translated into a universal protocol for fat grafting. Therefore, additional human studies are necessary to aid in the development of a universal protocol for clinical practice.

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Section: Processing Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

The Current State of Fat Grafting

Strong

Cederna

Rubin

et al. 2015

Plastic and Reconstructive Surgery

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356

129

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“…In aesthetic surgery, 85 % of American Society of Plastic Surgeons (ASPS) members now use fat grafting at least some of the time during rhytidectomy [50] and 28 % use fat grafting in aesthetic breast surgery [29]. Fat transfer is also widely utilized in breast reconstruction, where it is employed at least part of the time by 62 % of ASPS membership [54].…”

Section: Introductionmentioning

confidence: 99%

“…There are multiple disparate factors contributing to optimal conditions for fat graft survival including donor site [39, 56], medications utilized in tumescence solution [17, 25], aspiration pressure [49], reinjection rate [13, 38], fat harvesting technique [8, 24], and recipient site factors [26–28]. The efficient harvest, processing, and reinjection of fat, while less commonly discussed, are also important for the long-term success of this technique [29]. Shortening the duration that harvested adipocytes reside ex vivo may optimize the proportion remaining viable upon reinjection resulting in better retention and less fat necrosis.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…Kling et al recently found that 55% of surgeons favor hand held suction over vacuum-, water-, or ultrasonic-assisted harvest with the abdomen as the most common harvest site. 11 According to another survey, 12 the Coleman technique (54% of surgeons) is the preferred method of adipose harvest, followed by standard liposuction (25%), syringe techniques (16%) and direct excision (5%). The Coleman technique involves a 3-mm blunt cannula attached to a 10-mL Leur-Lok syringe.…”

Section: Introductionmentioning

confidence: 99%