Surgical Decision Making in Autologous Fat Grafting: An Evidence-Based Review of Techniques to Maximize Fat Survival

Abstract Autologous fat grafting is an important tool in plastic surgery and is widely used for a variety of applications, both aesthetic and reconstructive. Despite an ever-increasing list of indications and extensive research over many years into improving outcomes, fat grafting remains plagued by incomplete and often unpredictable graft survival. Decisions made at each stage of surgery can potentially contribute to ultimate success, including donor site selection and preparation, fat harvest, processing, and purification of lipoaspirate, recipient site preparation, and delivery of harvested fat to the recipient site. In this review, we examine the evidence for and against proposed techniques at each stage of fat grafting. Areas of consensus identified include use of larger harvesting and grafting cannulas and slow injection speeds to limit cell damage due to shearing forces, grafting techniques emphasizing dispersion of fat throughout the tissue with avoidance of graft pooling, and minimizing exposure of the lipoaspirate to the environment during processing. Safety considerations include use of blunt-tipped needles or cannulas to avoid inadvertent intravascular injection as well as awareness of cannula position and avoidance of danger zones such as the subgluteal venous plexus. We believe that using the evidence to guide surgical decision-making is the key to maximizing fat grafting success. Level of Evidence: 4

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The lateral edge and sourcil acetabular indices for surgical decision-making in developmental dysplasia of the hip

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200199 ◽

2020 ◽

Vol 14 (6) ◽

pp. 513-520

Author(s):

Alpesh Kothari ◽

Saqib Noor ◽

Connor L. Maddock ◽

Jan H. H. Vanderstappen ◽

Catharine S. Bradley ◽

...

Keyword(s):

Decision Making ◽

Acetabular Dysplasia ◽

Developmental Dysplasia ◽

Poor Agreement ◽

Level Of Evidence ◽

Surgical Decision ◽

Lateral Edge ◽

Surgical Decision Making ◽

Dysplasia Of The Hip ◽

Level Of Agreement

Purpose The acetabular index (AI) is a radiographic measure that guides surgical decision-making in developmental dysplasia of the hip (DDH). Two AI measurement methods are described; to the lateral edge of the acetabulum (AI-L) and to the lateral edge of the sourcil (AI-S). The purpose of this study was to determine the level of agreement between AI-L and AI-S on the diagnosis and degree of acetabular dysplasia in DDH. Methods A total of 35 patients treated for DDH with Pavlik harness were identified. The AI-L and AI-S were measured on radiographs (70 hips) at two and five years of age. AI-L and AI-S were then transformed relative to published normative data (tAI-L and tAI-S). Bland-Altman plots, linear regression and heat mapping were used to evaluate the agreement between tAI-L and tAI-S. Results There was poor agreement between tAI-S and tAI-L on the Bland-Altman plots with wide limits of agreement and no proportional bias. The two AI measurements were in agreement as to the presence and severity of dysplasia in only 63% of hips at two years of age and 81% at five years of age, leaving the remaining hips classified as various combinations of normal, mildly and severely dysplastic. Conclusion AI-L and AI-S have poor agreement on the presence or degree of acetabular dysplasia in DDH and cannot be used interchangeably. Clinicians are cautioned to prudently evaluate both measures of AI in surgical decision-making. Level of evidence I

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The Effect of Autologous Fat Grafting on Edema and Ecchymoses in Primary Open Rhinoplasty

Aesthetic Surgery Journal ◽

10.1093/asj/sjz075 ◽

2019 ◽

Cited By ~ 1

Author(s):

Kyle Gabrick ◽

Marc Walker ◽

Andrew Timberlake ◽

Fouad Chouairi ◽

Ean Saberski ◽

...

Keyword(s):

Immune Modulation ◽

Statistical Significance ◽

Three Dimensional ◽

Fat Grafting ◽

Area Measurement ◽

Open Rhinoplasty ◽

Autologous Fat Grafting ◽

Level Of Evidence ◽

Autologous Fat ◽

Soft Tissue Filler

AbstractBackgroundAutologous fat is a safe and effective soft tissue filler. Recent evidence also suggests improved wound healing and immune modulation with fat grafting.ObjectivesThe aim of this study was to describe a novel technique utilizing fat grafting during primary open rhinoplasty. We hypothesize a more rapid resolution of bruising and edema.MethodsPatients who underwent rhinoplasty were reviewed and compared by presence or absence of concurrent fat grafting. Three-dimensional images were analyzed employing Mirror (Vectra, Canfield Scientific, NJ). Ecchymoses were outlined utilizing a magnetic lasso followed by an area measurement. Volumetric edema measurements were also taken and assessed. Edema and ecchymosis were measured at 2 and 6 weeks postoperatively. Statistical significance was defined as P < 0.05.ResultsSixty-two patients were included. Thirty-three patients (53.2%) received autologous fat grafting and 29 (46.8%) did not. Age, gender, surgical approach, and osteotomy distribution were similar between the groups. The fat grafted group showed 7.29 cm2 fewer ecchymoses (P < 0.001) and 0.73 cc less edema (P = 0.68) in the early postoperative interval. Six weeks postoperatively, the fat grafted group showed 1 cc less edema (P = 0.36) with negligible differences in bruising.ConclusionsAutologous fat grafting is a useful adjunct to rhinoplasty and is associated with significantly fewer ecchymoses in the acute postoperative period.Level of Evidence: 4

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Severe fat embolism after autologous fat grafting in vaginal tightening and breast augmentation surgery

Journal of International Medical Research ◽

10.1177/0300060520949109 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094910

Author(s):

Chenyu Wang ◽

Xiaojun Wang ◽

Jiuzuo Huang ◽

Nanze Yu ◽

Xiao Long

Keyword(s):

Breast Augmentation ◽

Donor Site ◽

Pulmonary Arteries ◽

Aesthetic Surgery ◽

Maximum Size ◽

Fat Embolism ◽

Donor Site Morbidity ◽

Fat Grafting ◽

Autologous Fat Grafting ◽

Autologous Fat

Autologous fat grafting has become increasingly popular in the field of aesthetic surgery because of its biocompatibility and low donor site morbidity. However, some fatal complications may occur following the surgery. We herein describe a woman who developed severe fat embolism after autologous fat grafting for vaginal tightening and breast augmentation surgery. The patient developed symptoms of dyspnea and hypoxemia. Computed tomography pulmonary angiography showed multiple filling defects in the bilateral pulmonary arteries and branches with a maximum size of approximately 1.2 × 0.7 cm. Fat embolism was assumed to have occurred by injection of fat directly into the vessels around the vagina. Further research is needed to elucidate the anatomical mechanism underlying this phenomenon.

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Breast Reconstruction for Breast Asymmetry Using Recipient Site Pre-Expansion and Autologous Fat Grafting

Annals of Plastic Surgery ◽

10.1097/sap.0b013e3181a23f08 ◽

2009 ◽

Vol 62 (5) ◽

pp. 523-527 ◽

Cited By ~ 40

Author(s):

Daniel Del Vecchio

Keyword(s):

Breast Reconstruction ◽

Fat Grafting ◽

Autologous Fat Grafting ◽

Breast Asymmetry ◽

Recipient Site ◽

Autologous Fat

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Assessing Clinical Outcomes in Autologous Fat Grafting: A Current Literature Review

Aesthetic Surgery Journal ◽

10.1093/asj/sjab148 ◽

2021 ◽

Vol 41 (Supplement_1) ◽

pp. S50-S60

Author(s):

Teri N Moak ◽

Trina G Ebersole ◽

Damini Tandon ◽

Marissa Tenenbaum

Keyword(s):

Standard Of Care ◽

Fat Grafting ◽

The Body ◽

Autologous Fat Grafting ◽

Level Of Evidence ◽

Autologous Fat ◽

Aesthetic Appearance ◽

Radiologic Imaging ◽

The Face ◽

Surgeon Satisfaction

Abstract Autologous fat grafting, first described in the 1890s, has since undergone many modifications to optimize safety and efficacy. These changes have resulted in the technique that we now consider standard of care, one that is applied to reconstruction and cosmetic enhancement of the breast and the face both independently and in conjunction with surgical treatment. There is a growing body of evidence that this application has positive outcomes for patient satisfaction, surgeon satisfaction, and overall aesthetic appearance. This article summarizes the body of literature regarding these outcomes, reviews complications of fat grafting in the face and breast, and discusses controversies including radiologic imaging changes and longevity of grafting. Level of Evidence: 4

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Safety Considerations of Fat Grafting in Buttock Augmentation

Aesthetic Surgery Journal ◽

10.1093/asj/sjab092 ◽

2021 ◽

Vol 41 (Supplement_1) ◽

pp. S25-S30

Author(s):

Rebecca C O’Neill ◽

Summer E Hanson ◽

Edward Reece ◽

Sebastian Winocour

Keyword(s):

Mortality Rate ◽

Plastic Surgery ◽

Fat Embolism ◽

Fat Grafting ◽

Autologous Fat Grafting ◽

Level Of Evidence ◽

Autologous Fat ◽

The Past ◽

Safety Considerations ◽

A Current

Abstract Autologous fat grafting for buttock augmentation is one of the fastest growing plastic surgery procedures, but has also received significant publicity for the relatively high mortality rate secondary to fat emboli. The literature has grown exponentially in the past 5 years on this subject, helping to clarify our knowledge and providing recommendations to minimize risks, including avoiding intramuscular injections, placing the patient in the jackknife position, and utilizing larger-bore cannulas. Since the application of these recommendations, the rate of pulmonary fat embolism has decreased from 0.097% to 0.04%, with a current mortality of 1 in 14,921, making it statistically safer than abdominoplasty. Despite the evolution in our knowledge, techniques, and outcomes, it remains of utmost importance to properly select and educate patients about the safety of fat grafting for buttock augmentation. Level of Evidence: 4

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Primary Breast Augmentation with Autologous Fat Grafting Alone: Evaluation of Patient Satisfaction Using the BREAST-Q

Aesthetic Surgery Journal ◽

10.1093/asj/sjz352 ◽

2020 ◽

Vol 40 (11) ◽

pp. 1196-1204

Author(s):

Alexis Deschler ◽

Nathaniel Stroumza ◽

Rachel Pessis ◽

Arié Azuelos ◽

Michael Atlan

Keyword(s):

Patient Satisfaction ◽

Breast Augmentation ◽

Well Being ◽

Fat Grafting ◽

Autologous Fat Grafting ◽

Level Of Evidence ◽

Autologous Fat ◽

Large Breast ◽

High Satisfaction Rate ◽

Aesthetic Breast

Abstract Background Autologous fat grafting (AFG) for primary aesthetic breast augmentation has grown in popularity over recent years but patient satisfaction has never been objectively evaluated. Objectives The aim of the present study was to use the standardized BREAST-Q questionnaire to evaluate satisfaction in patients who had received primary aesthetic breast augmentation with AFG alone. Methods All recipients of primary aesthetic breast augmentation by AFG performed between 2013 and 2017 in our plastic surgery department were included. The primary endpoint was assessment of patient satisfaction with the standardized breast augmentation BREAST-Q questionnaire. Three additional questionnaires were used to evaluate patient and surgeon satisfaction. Results In total, 42 patients (84 breasts) underwent breast augmentation by AFG. Mean patient age was 34 years (range, 23-53 years). The mean volume of reinjected fat was 312.2 mL per breast (range, 130-480 mL). We observed significant improvement in all BREAST-Q postoperative items (excluding physical well-being) with a mean increase of 39 points (95% confidence interval: 28.97, 49.03; P < 0.001) regarding patient satisfaction with breasts. Overall, 82% of patients were satisfied with the result of their liposuction. Minor complications were encountered in 6 of our patients (14%). Conclusions Breast augmentation by AFG enhances patient satisfaction as measured by the BREAST-Q. This procedure has a high satisfaction rate and improves quality of life. Breast augmentation by AFG is a valid surgical option for moderate breast augmentation but is not an alternative to implants in large breast augmentation. Level of Evidence: 4

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Large-Volume Autologous Fat Grafting to the Breast

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa426 ◽

2021 ◽

Vol 41 (Supplement_1) ◽

pp. S16-S24

Author(s):

Maurice Y Nahabedian

Keyword(s):

Large Volume ◽

Breast Augmentation ◽

Small Volume ◽

Fat Grafting ◽

Autologous Fat Grafting ◽

Level Of Evidence ◽

Autologous Fat ◽

General Consensus

Abstract Autologous fat grafting in the setting of breast augmentation and reconstruction has become globally accepted and routinely performed. There is general consensus that small-volume grafting is reproducible and predictable; however, large-volume fat grafting (>100 mL) is less predictable and is not as commonly performed. The aim of this article was to review outcomes following large-volume and megavolume fat grafting in the setting of breast augmentation and reconstruction. Level of Evidence: 4

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