Fat Graft in Composite Breast Augmentation with Round Implants: A New Concept for Breast Reshaping

Abstract Background Autogenous fat grafting (AFG) is an established technique used as an adjunct to breast augmentation (BA) to redesign breast shape. Surgeons often use experience and intuition to estimate AFG volume, which can result in incorrect assessment of donor areas and unnecessary fat removal. Objectives This aim of this study was to develop a method based on a mathematical formula, which utilizes implant volume and projection to predict AFG volume. Methods Thirty patients (60 breasts) underwent primary hybrid BA. A software package (SketchUp) was used to simulate 3-dimensional AFG and implant volumes, which in turn were used to develop an equation for estimating AFG volume according to 3 different implant projections. The results for each group were compared, via Pearson’s correlation coefficient, with the results of the clinical series. Results All patients received Motiva Ergonomix SmoothSilk/SilkSurface implants, ranging in volume from 175 to 355 cc (mean, 265 cc), as well as an average AFG volume of 79.2 cc/breast (range, 50-110 cc). Twenty-nine patients (96.6%) were either very satisfied or satisfied during a mean follow-up of 18 months (range, 6-28 months). A high correlation was observed between the AFG performed in the cohort and predictions obtained from the formula (r = 0.938, P < 0.001). Conclusions The AFG volume in hybrid BA procedures can be estimated utilizing measurements based on implant volume/projection. This low-cost method can be applied to guide surgical decision-making in patients who are candidates for BA. Level of Evidence: 4

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Fat Graft Enhanced With Adipose-Derived Stem Cells in Aesthetic Breast Augmentation: Clinical, Histological, and Instrumental Evaluation

Aesthetic Surgery Journal ◽

10.1093/asj/sjz292 ◽

2019 ◽

Vol 40 (9) ◽

pp. 962-977 ◽

Cited By ~ 13

Author(s):

Pietro Gentile ◽

Ashutosh Kothari ◽

Donato Casella ◽

Claudio Calabrese

Keyword(s):

Stem Cells ◽

Soft Tissue ◽

Breast Augmentation ◽

Preoperative Evaluation ◽

Fat Graft ◽

Control Group ◽

Adipose Derived Stem Cells ◽

Level Of Evidence ◽

Breast Hypoplasia ◽

3D Volume

Abstract Background Fat graft enhanced with adipose-derived stem cells (FG-e-ASCs) has been utilized in outcomes of radiotherapy after mastectomy, breast soft tissue defects, ulcers, and loss of substance. The authors present their experience utilizing FG-e-ASCs in breast augmentation. Objectives The aim of this study was to evaluate the safety and efficacy of a study group (SG) regarding utilization of FG-e-ASCs in breast augmentation for aesthetic improvement, comparing the results with a control group (CG). Methods A total of 46 patients affected by breast hypoplasia were treated with FG-e-ASCs, comparing results with those of a CG (n = 30) treated with fat graft not enhanced with adipose-derived stem cells (FG-ne-ASCs). The preoperative evaluation included a complete clinical evaluation, a photographic assessment, magnetic resonance imaging of the soft tissue, ultrasound, and mammography. Postoperative follow-up took place at 1, 3, 7, 12, 24, and 48 weeks and then annually. Results The patients treated with FG-e-ASCs showed 58% maintenance of the contour restoring and of 3-dimensional (3D) volume after 3 years compared with the patients of the CG treated with FG-ne-ASCs, who showed 29% maintenance. In 67.4% (n = 31) of breast augmentations treated with FG-e-ASCs, we observed a restoration of the breast contour and an increase of 10.3 mm in the 3D volume after 36 months, which was observed in only 20.0% (n = 6) of patients in the CG treated with FG-ne-ASCs. Volumetric persistence in the SG was higher than that in the CG (P < 0.0001 SG vs CG). Conclusions Utilization of FG-e-ASCs was safe and effective in this series of cases performed. Level of Evidence: 4

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Commentary on: Fat Graft Enhanced With Adipose-Derived Stem Cells in Aesthetic Breast Augmentation: Clinical, Histological, and Instrumental Evaluation

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa064 ◽

2020 ◽

Vol 40 (9) ◽

pp. 978-980

Author(s):

Alexandra Condé-Green

Keyword(s):

Stem Cells ◽

Breast Augmentation ◽

Fat Graft ◽

Adipose Derived Stem Cells ◽

Instrumental Evaluation ◽

Aesthetic Breast

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Autologous Bone-Marrow-Derived-Mononuclear-Cells-Enriched Fat Transplantation in Breast Augmentation: Evaluation of Clinical Outcomes and Aesthetic Results in a 30-Year-Old Female

Case Reports in Surgery ◽

10.1155/2013/782069 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Dmitry Bulgin ◽

Erik Vrabic ◽

Enes Hodzic

Keyword(s):

Bone Marrow ◽

Breast Augmentation ◽

Mononuclear Cells ◽

Donor Site ◽

Autologous Bone Marrow ◽

Fat Graft ◽

Fat Transplantation ◽

Autologous Fat ◽

Autologous Fat Transfer ◽

Autologous Bone

Autologous fat transfer (lipofilling) is becoming an invaluable tool for breast augmentation as well as for breast reconstruction. Autologous lipofilling has several advantages, including biocompatibility, versatility, natural appearance, and low donor site morbidity. The main limitation is unpredictable fat graft resorption, which ranges from 25% to 80%, probably as a result of ischaemia and lack of neoangiogenesis. To obviate these disadvantages, several studies have searched for new ways of increasing the viability of the transplanted fat tissue. One promising approach is to enrich the fat graft with autologous bone-marrow-derived mononuclear cells (BMMNCs) before transplantation. BMMNCs produce many angiogenic and antiapoptotic growth factors, and their secretion is significantly enhanced by hypoxia. All of these mechanisms of actions could be beneficial for the stimulation of angiogenesis in ischemic tissues by BMMNCs administration. In our aesthetic surgery practice, we use fat transplantation enriched with BMMNCs, which caused a significant improvement in survival of fat grafts, compared with that of traditional lipofilling. Our experience with freshly isolated autologous fat enriched with BMMNCs for breast augmentation procedures is presented. The concept of this surgical and tissue handling technique is based on ability of BMMNCs to stimulate blood vessel growth.

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