[en] ("[en] BACKGROUND: The deep inferior epigastric perforator (DIEP) flap technique gives good clinical results, but aesthetic surgical adjustments are often necessary. Lipofilling represents a good complementary method, but fat resorption within the few months after surgery limits its use. Recently, a new protocol was introduced and successfully evaluated on murine models. This study aims to evaluate this protocol following a DIEP procedure by three-dimensional analysis.
METHODS: Within a period of 4 months, every patient having undergone breast reconstruction with DIEP and who required a lipofilling adjustment was invited to take part in this study. All surgeries were performed using the Adip'sculpt disposable medical device MACROFILL (Laboratoires SEBBIN, Boissy-l'Aillerie, France). Fat resorption was analyzed using a three-dimensional photography system.
RESULTS: Twenty-three patients were included, with a total of 25 breasts operated on. Injections were carried out on irradiated breasts in 73% of cases, and average injection volume was 124 mL (SD = 39 mL), whereas average operating time was 68 minutes (44-96 minutes). At an average follow-up of 5 months (4-8 months), 70.9% of projection gain afforded by the lipofilling was still present.
CONCLUSIONS: It is now clear that particular rules should be respected for an efficient lipofilling, particularly regarding aspiration cannula characteristics, vacuum used, and the necessity of washes and soft centrifugations. We demonstrate here that by following a specific protocol that addresses these precautions, while using material that is specifically adapted, a 70.9% fat survival rate can be achieved, even in the very unfavorable case of postirradiation DIEP breast reconstruction.","[en] ","")
Disciplines :
Surgery
Author, co-author :
Nelissen, Xavier ; Université de Liège - ULiège > Faculté de Médecine > Doct. sc. méd. (paysage) ; Clinique Mont Saint-Martin, Mont Saint-Martin, Liège, Belgium
Lhoest, Florence; Clinique Mont Saint-Martin, Mont Saint-Martin, Liège, Belgium
Preud'Homme, Laurence; Clinique Mont Saint-Martin, Mont Saint-Martin, Liège, Belgium
Language :
English
Title :
Refined Method of Lipofilling following DIEP Breast Reconstruction: 3D Analysis of Graft Survival.
Haekens CM, Enajat M, Keymeulen K, et al. Self-esteem and patients' satisfaction after deep inferior epigastric perforator flap breast reconstruction. Plast Surg Nurs. 2011;31:160-166.
Hamdi M, Weiler-Mithoff EM, Webster MH. Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps. Plast Reconstr Surg. 1999;103: 86-95.
Nahabedian MY, Momen B, Galdino G, et al. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg. 2002;110:466-475; discussion 476.
Tønseth KA, Hokland BM, Tindholdt TT, et al. Quality of life, patient satisfaction and cosmetic outcome after breast reconstruction using DIEP flap or expandable breast implant. J Plast Reconstr Aesthet Surg. 2008;61:1188-1194.
Enajat M, Smit JM, Rozen WM, et al. Aesthetic refinements and reoperative procedures following 370 consecutive DIEP and SIEA flap breast reconstructions: important considerations for patient consent. Aesthetic Plast Surg. 2010;34:306-312.
Weichman KE, Broer PN, Tanna N, et al. The role of autologous fat grafting in secondary microsurgical breast reconstruction. Ann Plast Surg. 2013;71:24-30.
Neuber F. Fettransplantation. Bericht über die Verhandlungen der deutschen Gesellschaft für Chirurgie. Zentralbl Chir. 1893;22:66.
Coleman SR. Facial recontouring with lipostructure. Clin Plast Surg. 1997;24:347-367.
EL Fadl D,Garimella V,Mahapatra TK,etal.Lipomodelling of the breast: a review. Breast 2010;19:202-209.
Cheriyan T, Kao HK, Qiao X, et al. Low harvest pressure enhances autologous fat graft viability. Plast Reconstr Surg. 2014;133:1365-1368.
Nguyen PS, Desouches C, Gay AM, et al. Development of micro-injection as an innovative autologous fat graft technique: the use of adipose tissue as dermal filler. J Plast Reconstr Aesthet Surg. 2012;65:1692-1699.
Condé-Green A, de Amorim NF, Pitanguy I. Influence of decantation, washing and centrifugation on adipocyte and mesenchymal stem cell content of aspirated adipose tissue: a comparative study. J Plast Reconstr Aesthet Surg. 2010;63:1375-1381.
Dos-Anjos Vilaboa S, Llull R, Mendel TA. Returning fat grafts to physiologic conditions using washing. Plast Reconstr Surg. 2013;132:323e-326e.
Kurita M, Matsumoto D, Shigeura T, et al. Influences of centrifugation on cells and tissues in liposuction aspirates: optimized centrifugation for lipotransfer and cell isolation. Plast Reconstr Surg. 2008;121:1033-1041; discussion 1042-1043.
Xie Y, Zheng D, Li Q, et al. The effect of centrifugation on viability of fat grafts: an evaluation with the glucose transport test. J Plast Reconstr Aesthet Surg. 2010;63:482-487.
Hoareau L, Bencharif K, Girard AC, et al. Effect of centrifugation and washing on adipose graft viability: a new method to improve graft efficiency. J Plast Reconstr Aesthet Surg. 2013;66:712-719.
Herold C, Ueberreiter K, Busche MN, et al. Autologous fat transplantation: volumetric tools for estimation of volume survival. A systematic review. Aesthetic Plast Surg. 2013;37:380-387.
Losken A, Seify H, Denson DD, et al. Validating three-dimensional imaging of the breast. Ann Plast Surg. 2005;54:471-476; discussion 477-478.
Choi M, Small K, Levovitz C, et al. The volumetric analysis of fat graft survival in breast reconstruction. Plast Reconstr Surg. 2013;131:185-191.
Small K, Choi M, Petruolo O, et al. Is there an ideal donor site of fat for secondary breast reconstruction? Aesthet Surg J. 2014;34:545-550.
Bar-Meir ED, Yueh JH, Tobias AM, et al. Autologous fat grafting: a technique for stabilization of the microvascular pedicle in DIEP flap reconstruction. Microsurgery 2008;28:495-498.
Nguyen A, Pasyk KA, Bouvier TN, et al. Comparative study of survival of autologous adipose tissue taken and transplanted by different techniques. Plast Reconstr Surg. 1990;85:378-386; discussion 387-389.
Kononas TC, Bucky LP, Hurley C, et al. The fate of suctioned and surgically removed fat after reimplantation for soft-tissue augmentation: a volumetric and histologic study in the rabbit. Plast Reconstr Surg. 1993;91:763-768.
Delay E, Streit L, Toussoun G, et al. Lipomodelling: an important advance in breast surgery. Acta Chir Plast. 2013;55:34-43.
Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg. 2007;119: 775-785; discussion 786-787.
Eto H, Kato H, Suga H, et al. The fate of adipocytes after non-vascularized fat grafting: evidence of early death and replacement of adipocytes. Plast Reconstr Surg. 2012;129:1081-1092.
