Abstract :
[en] Autologous fat transfer (AFT), or lipofilling, is today a major technique in reconstructive and aesthetic surgery, particularly for breast reconstruction after cancer. Despite its rapid expansion, its use remains limited by the unpredictability of outcomes, primarily due to the variability of cell survival (30–80%). Previous controversies were mainly related to oncological safety and radiological impact. Recent publications, including a meta-analysis, have provided reassuring evidence on both aspects.
The objective of this work is twofold: first, to evaluate the technical factors influencing adipose tissue viability; and second, to validate and compare new purification methods with a view toward standardizing lipofilling. To this end, both a clinical study and an experimental study were conducted.
The first clinical study, carried out in patients who underwent breast reconstruction with a DIEP flap, demonstrated that a protocol combining gentle aspiration, repeated washings, and moderate centrifugation allowed for stable volumetric survival (70.9% at 5 months postoperatively). Critical parameters identified include the reduction of aspiration pressure, the use of fine cannulas, tissue washing to eliminate harmful components, and centrifugation at moderate speed.
The second experimental study compared five purification techniques: decantation, Coleman centrifugation, Macrofill® (gentle centrifugation with washings), Puregraft® (passive filtration), and Adipure® (automated active filtration). In-vitro and in-vivo results demonstrated that decantation was the least effective method, whereas filtration techniques, particularly Adipure®, provided superior tissue viability and reduced the proportion of residual oil, resulting from adipocyte lysis.
Histological and volumetric efficacy obtained with Adipure® confirmed its advantage for achieving a more reproducible and higher-quality graft.
This work thus highlights the importance of a rigorous and standardized approach to optimize the safety and reliability of AFT. It paved the way for the development of a fully automated closed-system device (ADIMATE®), integrating gentle aspiration, successive washings, and active filtration. The purpose of this device is to minimize inter-operator variability, optimize cell viability, and thereby enhance both the safety and predictability of lipofilling in plastic surgery.
