Power-Assisted Liposuction and Lipofilling: Techniques and Experience in Large-Volume Fat Grafting

Jean S, Kabaria N, Gardocki-Sandor M, Cottler PS. Preclinical Volume Retention of Fat Grafts Processed with REVOLVE™ Technology or Decantation Methods in Irradiated and Nonirradiated Wounds

Background: The processing of harvested fat for transplantation is critical to fat graft performance. In breast reconstruction, larger volumes of fat are being grafted and, in some clinical cases, are being implanted within radiated tissue. This preclinical animal study evaluated the effects of radiation on retention volume and fat graft quality after processing by decantation or REVOLVE™ technology (Allergan Aesthetics, an AbbVie Company), a filtration-based device that can process lipoaspirates and remove unwanted contaminants prior to grafting. Methods: Lipoaspirate was collected from human donors (n = 6), processed using either REVOLVE™ technology or decantation, and implanted (0.5 cc) into 60 athymic mice for 4 weeks with or without a single 35-Gy radiation dose 12 weeks prior. Volume composition, MRI, and weight-based volumetric assessment of grafted fat were performed and compared between radiated and non-radiated mice. Results: Volume composition analysis demonstrated significantly higher fat content and lower aqueous fluid with REVOLVE™ technology than with decantation, with minimal cellular debris and free oil. MRI-based and weight-based volume analysis demonstrated a significantly higher percent retention with REVOLVE™ technology than decantation in nonirradiated and irradiated sites, respectively. Pathology scoring showed a significant decrease in fibrosis within grafts processed with REVOLVE™ technology in nonirradiated sites. Conclusions: Results suggest that fat processed using REVOLVE™ technology provides better early volume retention and quality of fat grafts compared to decantation, both in healthy and radiation-treated surgical sites.

Scarpa fascia preservation abdominoplasty combined with precise liposuction for postpregnancy abdomen: A 10-year experience

BACKGROUND

Abdominoplasty is widely performed in plastic surgery. Currently, there is a high demand for abdominoplasty among women who experience abdominal wall laxity after pregnancy. The aim of this study was to present modified abdominoplasty combined with power-assisted liposuction and ultrasound-assisted liposuction for postpregnancy women with abdominal wall laxity.

METHODS

This retrospective study included a total of 190 cases of postpartum women presenting with abdominal wall laxity from January 2015 to April 2023. The patients were divided into 2 groups: the abdominoplasty and abdominoplasty combined with precise liposuction groups. The age, body mass index, reproductive history, abdominal circumference, surgical strategy, surgical details, and complications were considered during evaluation. Patient satisfaction was evaluated using a questionnaire that incorporated the visual analog scale (VAS) and Beck Depression Inventory (BDI).

RESULTS

The average postoperative follow-up period in this study group was 10.1 months. The abdominoplasty combined with precise liposuction group exhibited significantly reduced upper and lower abdominal circumferences compared to the abdominoplasty group (P<0.05). The postoperative VAS score of the combined group was significantly higher than that of the abdominoplasty group (P<0.05), while the postoperative BDI score of the combined group was significantly lower compared to that of the abdominoplasty group (P<0.05). The BDI results revealed a significant reduction in the prevalence of moderate depression among post-surgery patients, declining from 94.2% to 3.6%.

CONCLUSIONS

Scarpa fascia preservation abdominoplasty combined with precise liposuction is a suitable procedure for postpregnancy abdomen. The modified abdominoplasty demonstrates favorable therapeutic outcomes, optimal flap blood supply, minimal flap tension, inconspicuous postoperative scar, and meticulous body contouring.

Bibliometric Analysis of Hot Trends and Future Prospects in Clinical Fat Research from 2014 to 2023

BACKGROUND

Significant advancements have been made in the field of clinically relevant fat research over the past decade. A systematic analysis of publications in this domain is essential. This study aims to identify research hotspots and evolving trends in clinically relevant adipose tissue research through bibliometric analysis.

METHODS

Publications related to fat clinical research from 2014 to 2023 were extracted and analyzed from the Web of Science (WOS) Core Collection database. The data from this 10-year period were divided into two 5-year intervals (2014-2018 and 2019-2023) for analysis. Various aspects such as author keywords, countries, institutions, authors, and journal co-occurrence were studied. The data were analyzed and visualized using VOSviewer.

RESULTS

After selecting the retrieval strategy, a total of 892 publications were extracted for the period 2014-2018 and 1622 publications for 2019-2023. Comparing the two intervals, the United States was the country with the highest number of publications (354 publications vs. 546 publications). The institution with the highest output was Peking Union Medical College (26 publications vs. 87 publications). The most prolific author was Klinger M (4 publications) vs. Hua Zuguang (18 publications). The most active journal was Plastic and Reconstructive Surgery (178 publications) vs. Aesthetic Surgery Journal (244 publications). The most active research areas were focused on "fat grafting," "liposuction," and "body contouring," with a rapid increase in research related to "facial rejuvenation" using fat grafting, suggesting it may be the next research hotspot.

CONCLUSION

Clinical research related to fat is rapidly evolving. This study provides a visual network and trend analysis of fat research over the past decade.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Fat Grafting to the Breast for Aesthetic Indications: Techniques and Outcomes in 165 Consecutive Patients

PURPOSE

Fat grafting to the breast for aesthetic indications has become increasingly popular. Herein, methods, aesthetic outcomes, and complications are reviewed in a retrospective case series.

METHODS

Female patients (n=165) with an average age of 45 years (range: 17-78 years) who underwent fat grafting to breast were evaluated. Demographic parameters, the type of procedure, the amount of fat transferred, the site(s) of fat harvest, operative times, and the patient's postoperative recovery and outcomes were recorded.

RESULTS

Of the 165 patients, 105 had breast augmentation with fat only. Of these 105 patients, 14(8%) had implant removal with and without capsulectomy, and 61(37%) had mastopexies. Composite augmentation was performed in the remaining 60 patients. The average amount of fat used was 208 cc (range: 10 to 945 cc) per breast. Forty-five patients (27%) underwent a second procedure. Of the 165 patients, 37(22%) had adverse events unrelated to the fat graft, including suture abscesses, scarring, and minor incision cite skin breakdown. Four patients (2.4%) had a complication related to fat grafting including 'lump' formation between the breast, abnormal mammograms, and the need for simple aspiration of a lipid cyst.

CONCLUSIONS

Autologous fat grafting should be considered for both primary and secondary aesthetic breast surgery to enhance outcomes. Complications related to fat grafting are uncommon. Revisional and secondary surgeries may be needed to achieve the desired outcome. Power-assisted liposuction, with vibratory infiltration of the tumescent solution, auto-infusion of fat, and Expansion Vibration Lipofilling using a closed system has become our preferred technique. Fat grafting to breast can be considered for both primary and secondary aesthetic breast surgery Complications related to fat grafting are uncommon There does not appear to be an overall increase in complications of associated mastopexy and composite augmentation LEVEL OF EVIDENCE V: This journal requires that 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 .

Combining Gluteal Shaping with High-Definition Liposuction: New Concepts and Techniques

Gluteal contouring has been subject to numerous publications in aesthetic plastic surgery. Not only the female but also the male features that govern such procedures have been thoroughly described by different authors. In this article, we will provide the reader with an updated account of how gluteal contouring blends with High Definition Liposculpture (HDL). We discuss the most current techniques for buttocks reshaping through a holistic approach of new anatomical and artistic concepts. We will dive into new techniques to perform multiplanar and 4-dimensional Fat Grafting and equalization of the buttocks and surrounding areas, which we believe might help plastic surgeons to improve the quality of their patient outcomes. In effect, a proper understanding of the anatomical structures and its variations among different gender and ethnicities, will both help the surgeon to individualize the procedure based on patient preferences.

Cosmetic Breast Augmentation Using Power-Assisted Liposuction and Lipofilling: A Prospective Study

INTRODUCTION

Autologous fat transfer is becoming a more and more widespread procedure in aesthetic breast surgery. Power-assisted technology produces oscillating reciprocal movements of cannula tip, which reproduce the motion of the operator's arm with lower amplitude. The power-assisted mechanism can be applied to the fat liposuction and injection phases. The aim of this study is to report our experience on autologous fat transfer in primary cosmetic breast augmentation using power-assisted liposuction and lipofilling (PALL), our surgical technique and on long-term cosmetic results, and patient-reported outcomes.

MATERIALS AND METHODS

A prospective observational study was performed including all patients who underwent PALL cosmetic breast augmentation. Collected data included patient's age, BMI, mean liposuction and fat injection volume, mean operating time, postoperative complications, mean number of grafting procedures required to achieve the desired outcome, cosmetic results and patient satisfaction.

RESULTS

A total of 43 patients were included with a mean follow-up of 13.32 months. Mean liposuction and injection volumes were 1884.54 mL and 399.03 mL, respectively. Mean number of grafting procedures was 1.27. With respect to aesthetic outcomes, the mean score for breast volume, shape, symmetry and donor site shape was 4.38, 4.22, 4.27 and 4.42, respectively. Regarding patient satisfaction, the mean score for breast volume, shape, symmetry and donor site shape was 4.22, 5, 5 and 4.77, respectively.

CONCLUSION

The current study is the first prospective report on primary cosmetic breast augmentation using PALL. Although our sample of patients is limited, our results showed that PALL primary breast augmentation is an efficient procedure, which leads to satisfactory results for both patients and surgeons.

LEVEL OF EVIDENCE IV

This journal requires that 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 .

Gluteal Augmentation with Fat Grafting: Literature Review

BACKGROUND

The buttock is the second sex feature of the human body, and the graceful buttock curve gives people confidence. Although the safety of gluteal augmentation with autologous fat grafting is still controversial, the proportion of operations is increasing year by year.

PURPOSE

To provid a comprehensive and detailed review of the literature on gluteal augmentation with fat grafting.

METHODS

A comprehensive review of the published literature through September of 2020 was performed in PubMed database, with the search terms "gluteal augmentation," "buttock augmentation," "Brazilian buttock lift," "fat grafting," "fat transfer," "gluteal AND aesthetic," "gluteal AND anatomy."

RESULTS

A total of 64 articles were included. On the basis of the information obtained, surgical recommendations are proposed to achieve buttocks as close as possible to aesthetic standard and improve surgical safety.

CONCLUSION

With a good grasp of the anatomical structure of the buttocks, complications can be reduced. At the same time, based on the theoretical basis of buttock aesthetics, better postoperative results can be obtained.

LEVEL OF EVIDENCE III

This journal requires that 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 .

Revision Breast Augmentation

Breast augmentation is consistently one of the most commonly performed aesthetic operations every year. Unfortunately, revision rates following primary augmentation remain as high as 36%. There are several causes for revision breast augmentation; however, the most common and challenging of these include capsular contracture, implant malposition, and ptosis of the aging breast following augmentation. Successful management of these problems requires knowledge on how to best treat the implant and capsule with the corresponding soft tissue simultaneously. While surgical management is important, understanding the pathological causes of these entities during the primary operation can reduce the need for revision. This article utilizes the most up-to-date literature to review the appropriate clinical evaluation and surgical management of these complex cases.

The Combined Effect of Intravenous and Topical Tranexamic Acid in Liposuction: A Randomized Double-Blinded Controlled Trial

Background

Tranexamic acid (TXA) use in surgical procedures due to its hemostatic effects has been gaining an increased interest. In plastic surgery, the effects of TXA have been studied intravenously (IV), and there have been some reports regarding local use.

Objectives

A comparative study examining the combined effect of IV and local TXA was conducted.

Methods

A randomized double-blinded controlled trial was performed for patients undergoing breast reduction treatment with liposuction and resection following the power-assisted liposuction mammaplasty (PALM) technique. All patients received 5 mL IV of 0.5 g/5 mL TXA on induction. Before installation, one researcher prepared two solutions of 1 L normal saline: one with 5 mL of 0.5 g/5 mL TXA associated with epinephrine 1:100,000 and the other with only epinephrine 1:100,000. These were randomly infiltrated in either the left or right breast. Clinical dermal bleeding was assessed for both breasts after deepithelialization. The lipoaspirate from these breasts was then compared with each other. A postoperative evaluation at 24 hours was performed to compare the ecchymosis rate.

Results

Ratios of decanted volume to total lipoaspirate was measured in bottles and compared between breasts. There was a statistical difference (P = 0.0002) in the ratio of decanted to lipoaspirated volume when comparing the control group (ratio: 0.21) with the treatment group (0.13). Video analysis revealed decreased dermal bleeding in the TXA group and postoperative evaluation less ecchymosis.

Conclusions

The combined use of IV and local TXA can help reducing blood loss in liposuction as measured by decantation in separate drain bottles and as assessed clinically preoperatively and postoperatively.

Level of Evidence 2

A novel approach in breast reconstruction: The extended lateral thoracic flip-over flap combined with loops and lipofilling (ELT FOLL)

INTRODUCTION

The use of the thoracodorsal musculocutaneous flap has been limited to donor site complications, whereas the thoracodorsal fasciocutaneous flap spares the muscle and limits morbidities. Our objective is to describe a new technique of breast reconstruction using an extended lateral thoracic (ELT) flip-over flap combined with loops and lipofilling (ELT FOLL) to achieve better breast remodeling.

METHODS

Between 2013 and 2018, 64 patients underwent breast reconstruction using an ELT FOLL. The flap is designed in an elliptical transverse pattern and extends 2 cm lateral to the back midline up to the breast axis at the level of the inframammary fold. The surgical technique consists of an infiltration and tunnelization of the breast recipient site and surrounding area, deepithelialization of the skin paddle, and additional preparation of the flaps and loops. Liposuction is performed using the power-assisted liposuction and lipofilling technique, and lipofilling is achieved throughout the thoracic cutaneous surface of the reconstructed site, particularly into the lower quadrant of the breast.

RESULTS

Among the reconstructions, 73.4% was delayed and 92.2% was unilateral. A fourth of the patients were smokers, and 39.1% received radiotherapy. The total complication rate was 8.7%, the patient's shoulder function was not affected at long term, with the DASH score rising from 6.53 preoperatively to 11.32 at 6 weeks and 7.52 at 6 months. The average operative time was 57 min, and drains were removed at day one after surgery.

CONCLUSION

The ELT FOLL should be considered a simple, safe, and reliable alternative for breast reconstruction.