Jet-assisted fat transfer to the female breast: preliminary experiences
Nowadays, autologous fat grafting is used as a versatile tool for distinct touch-ups after performed breast reconstruction or aesthetic augmentation. Different approaches of fat harvest, filtering, and reinjection have been described in last three decades. After the first report in 2010, the Berlin Autologous Lipotransfer (BEAULI) method became one of the latest popular techniques in the field of large volume fat grafting. Preliminary experiences with the rising jet-assisted fat transfer in a large case series of two specialized European centers are presented.
Retrospective analysis enrolled over 167 female nonsmokers with reconstructive or aesthetic indications treated with at least one procedure according to the standardized protocol of the BEAULI™ technique from February 2010 to June 2012. Patients with weight changes >5 kg and endocrine or cardiovascular comorbidities have been excluded. Demographics and items of the treatment (i.e., grafted volumes per procedure) were enlisted for evaluation. The first outcome has been estimated based on complications rate, pain report (VAS score), and digital photographs after at least 6 months of follow-up.
The included 132 patients (240 breasts) had a mean age of 39.7 years and underwent 487 autologous jet-assisted fat transfer procedures with minor complications (5.35 %) like tiny oil cysts formations or hematoma of the donor site. Low postoperative pain (88.6 % with VAS 1 to 4) has been reported during the first week, and final aesthetic evaluation showed good to excellent results. We observed a higher frequency of procedures, especially in irradiated patients (>3.62) compared to the rest of reconstructive cases (>2.78). The presented data helped us to differentiate the treatment according to the respective indications (reconstructive vs. aesthetic) and to optimize our intern protocol.
Water-jet-assisted liposuction with consecutive immediate mammary fat injection is a procedure with a short hospitalization and low complication rate. Based on the preliminary results in the use of the BEAULI™ technique for breast reconstruction and aesthetic augmentation, the authors presume that it can be safely applied for these specific patient groups. Although further studies including long-term follow-up are certainly required to constantly control and compare the presented method to other autologous fat grafting techniques.
Level of Evidence: Level III, therapeutic study.
KeywordsAutologous fat grafting Breast reconstruction Tissue regeneration Breast augmentation Liposuction Lipofilling Water-jet
We thank Human Med Inc. (Germany/USA) for providing the lipotransfer sets.
Conflict of interest
This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. An institutional review board was not required as all reported devices were cleared for marketing by the FDA. All persons gave their informed consent prior to their inclusion in this study.
- 2.Losken A, Pinell XA, Sikoro K et al (2011) Autologous fat grafting in secondary breast reconstruction. Ann Plast Surg 66(5):518–522Google Scholar
- 3.Saint-Cyr M, Rojas K, Colohan S et al (2012) The role of fat grafting in reconstructive and cosmetic breast surgery: a review of the literature. J Reconstr Microsurg 28:99–110Google Scholar
- 4.Kanchwala SK, Glatt BS, Conant EF, Bucky LP (2009) Autologous fat grafting to the reconstructured breast: the management of acquired deformities. Plast Reconstr Surg 124:409–418Google Scholar
- 5.Neuber G (1893) Über die Wiederanheilung vollständig vom Körper getrennter, die ganze Fettschicht enthaltener Hautstücke. Zbl F Chirurgie 30:16Google Scholar
- 6.Coleman SR, Saboeiro AP (2007) Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg 119(3):775–785, p. discussion 786–7Google Scholar
- 7.Rohrich RJ, Sorokin ES, Brown SA (2004) In search of improved fat transfer viability: a quantitative analysis of the role of centrifugation and harvest site. Plast Reconstr Surg 113(1):391–395, discussion 396–7Google Scholar
- 8.Tan PH, Lai LM, Carrington EV et al (2006) Fat necrosis of the breast—a review. Breast 15(3):13–318Google Scholar
- 9.Spear SL, Wilson HB, Lockwood MD (2005) Fat injection to correct contour deformities in the reconstructed breast. Plast Reconstr Surg 116(5):1300–59Google Scholar
- 10.Lee JH et al (2013) The effect of pressure and shear on autologous fat grafting. Plast Reconstr Surg 131(5):1125–1136Google Scholar
- 17.Herold C, Ueberreiter K et al (2013) Autologous fat transplantation: volumetric tools for estimation of volume survival. A systematic review. Aesthetic Plast Surg 37(2):380–7Google Scholar
- 20.Yoshimura K, Sato K, Aoi N et al (2008) Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg 32(1):48–55Google Scholar
- 21.Missana MC, Laurent I et al (2007) Autologous fat transfer in reconstructive breast surgery: indications, technique and results. Eur J Surg Oncol 33(6):685–690Google Scholar
- 22.Condé-Green A, de Amorim NF, Pitanguy I (2010) Influence of decantation, washing and centrifugation on adipocyte and mesenchy- mal stem cell content of aspirated adipose tissue: a comparative study. J Plast Reconstr Aesthet Surg 63(8):1375–1381Google Scholar
- 23.Hyakusoku H, Ogawa R, Ono S, Ishii N, Hirakawa K (2009) Complications after autologous fat injection to the breast. Plast Reconstr Surg 123(1):360–370Google Scholar
- 24.Wang H, Jiang Y, Meng H, Zhu Q et al (2010) Sonographic identification of complications of cosmetic augmentation with autologous fat obtained by liposuction. Ann Plast Surg 64(4):385–389Google Scholar
- 25.Lee KS, Seo SJ, Park MC et al (2011) Sepsis with multiple abscesses after massive autologous fat grafting for augmentation mammoplasty: a case report. Aesthetic Plast Surg 35(4):641–5Google Scholar
- 26.Rennekampff HO, Reimers K, Gabka CJ et al (2010) Möglichkeiten und grenzen der autologen fetttransplantation–“Consensus Meeting” der DGPRÄC in Hannover, September 2009. Handchir Mikrochir Plast Chir 42:137–142Google Scholar
- 27.Gutowski KA; ASPS Fat Graft Task Force (2009) Current applications and safety of autologous fat grafts: a report of the ASPS fat graft task force. Plast Reconstr Surg 381 124(1):272–280Google Scholar
- 28.Villani F et al (2010) Current applications and safety of autologous fat grafts: a report of the ASPS Fat Graft Task Force. Plast Reconstr Surg 125(2):758–759, author reply 759Google Scholar
- 31.Liao HT, Marra KG, Rubin JP (2013) Application of platelet-rich plasma and platelet-rich fibrin in fat grafting: basic science and literature review. Tissue Eng Part B Rev. doi: 10.1089/ten.TEB.2013.0317
- 32.Choi YD, Shin HS, Mok JO (2014) Impaired survival of autologous fat grafts by diabetes mellitus in an animal model: a pilot study. Aesthet Surg J 34(1):168–174Google Scholar
- 33.Largo RD et al (2013) Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: a systematic review. J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2013.11.011
- 34.Herold C, Ueberreiter K, Cromme F et al (2010) Is there a need for intrapectoral injection in autologous fat transplantation to the breast?—An MRI volumetric study. Handchir Mikrochir Plast Chir 42:129–134Google Scholar
- 35.Ueberreiter K, Tanzella U, Cromme F (2011) Autologe Fetttransplantation als Salvage-Verfahren nach Kapselkontraktur von Brustimplantaten. Ästh Chirurgie 26:1–8Google Scholar
- 36.Hoppe DL, Stabile M et al (2013) Breast reconstruction de novo by water-jet assisted autologous fat grafting—a retrospective study. Ger Med Sci Dec 12;11: Doc17Google Scholar
- 37.Munch DP (2013) Breast augmentation with autologous fat—experience of 96 procedures with the BEAULI-technique. Handchir Mikrochir Plast Chir Apr 45(2):80–92Google Scholar
- 43.Ranganathan K et al (2013) Fat grafting for thermal injury: current state and future directions. J Burn Care Res 34(2):219–226Google Scholar
- 46.Bertolini F, Lohsiriwat V, Petit JY, Kolonin MG (2012) Adipose tissue cells, lipotransfer and cancer: a challenge for scientist, oncologists and surgeons. Biochim Biophy Acta 1826(1):209–214Google Scholar
- 49.Rubin JP, Coon D et al (2012) Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study. Plast Reconstr Surg 129(5):1029–1038Google Scholar
- 50.Amar O, Bruant-Rodier C, Lehmann S et al (2008) Fat tissue trans- plant: restoration of the mammary volume after conservative treatment of breast cancers, clinical and radiological considerations. Ann Chir Plast Esthet Apr 53:169–177Google Scholar
- 52.Pierrefeu-Lagrange AC, Delay E, Guerin N et al (2006) Radiological evaluation of breasts reconstructed with lipomodeling. Ann Chir Plast Esthet Feb 51(1):18–28Google Scholar
- 53.Herold C et al (2010) MRI-based breast volumetry-evaluation of three different software solutions. J Digit Imaging Oct 23(5):603–610Google Scholar