Current Fat Grafting Practices and Preferences: A Survey from Members of ISPRES.

Unlabelled: Fat grafting has established its niche in a wide spectrum of aesthetic and reconstructive procedures. A consensus-based method of harvest, processing, enrichment, injection, and assessment is lacking, despite the rising trends in its application. We conducted a survey among plastic surgeons to evaluate and identify trends of fat grafting practices.

Injectable Allograft Adipose Matrix Supports Adipogenic Tissue Remodeling in the Nude Mouse and Human.

Background: Adipose tissue reaches cellular stasis after puberty, leaving adipocytes unable to significantly expand or renew under normal physiologic conditions. This is problematic in progressive lipodystrophies, in instances of scarring, and in soft-tissue damage resulting from lumpectomy and traumatic deformities, because adipose tissue will not self-renew once damaged. This yields significant clinical necessity for an off-the-shelf de novo soft-tissue replacement mechanism.

Autologous Fat Transfer After Augmentation and Reconstruction of the Female Breast: An International, Cross-Sectional Photo-Comparison Study Among Different Physician and Laymen Study Groups.

Objective: The aim of this study is to compare the cosmetic evaluation of autologous fat transfer (AFT) for various indications between surgeons and different laymen groups.

Background Data: Despite the upsurge in AFT scientific/clinical interest, objectifying satisfaction has only recently progressed beyond simple Likert-type/Visual Analog Scales. Furthermore, differences in satisfaction between laymen and surgeons has not been thoroughly studied.

Percutaneous Mesh Expansion: A Regenerative Wound Closure Alternative.

Background: Puncture wounds in the 1-mm range usually heal without scars. Stacking rows of these punctures offers a scarless method to generate tissue by mesh expansion. The authors developed a percutaneous mesh expansion procedure and present their experience for its wound closure application.

Current Clinical Applications of Fat Grafting.

Learning Objectives: After reading this article, the participant should be able to: 1. Understand the theory and principles behind successful avascular fat transfer; 2. Apply these principles into techniques that yield safe and successful fat grafting operations; 3.

Tissue-Engineered Autologous Breast Regeneration with Brava®-Assisted Fat Grafting.

A technique of whole and partial breast reconstruction is described based on tissue-engineering principles. Brava-assisted external tissue expansion generates an in situ biological recipient scaffold that favors the survival of large volumes of autologous fat graft required for breast reconstruction. Also presented are the results of the authors' multicenter experience with this regenerative alternative in 488 patients over a 7-year period tracking surgical complications, patient satisfaction, efficacy, and costs.

A Cost-Utility Analysis Comparing the Sartorius versus the Rectus Femoris Flap in the Treatment of the Infected Vascular Groin Graft Wound.

Background: The purpose of this study was to examine the sartorius and rectus femoris flaps as reasonable coverage options for the infected vascular groin graft wound. The authors' goal was to perform a cost-utility analysis of the sartorius flap versus the rectus femoris flap in the treatment of an infected vascular groin graft.

Methods: Cost-utility methodology involved a literature review compiling outcomes for specific flap interventions, obtaining utility scores for complications to estimate quality-adjusted life-years, accruing costs using Diagnosis-Related Group and Current Procedural Terminology codes for each intervention, and developing a decision tree that could portray the more cost-effective strategy.

Tissue-engineered breast reconstruction with Brava-assisted fat grafting: a 7-year, 488-patient, multicenter experience.

Background: The ability of autologous fat transfer to reconstruct an entire breast is not established. The authors harnessed the regenerative capabilities of external expansion and autologous fat transfer to completely reconstruct breasts.

Methods: The authors performed 1877 Brava plus autologous fat transfer procedures on 616 breasts in 488 women to reconstruct 99 lumpectomies, 87 immediate breast reconstructions, and 430 delayed total breast reconstructions.

Megavolume autologous fat transfer: part II. Practice and techniques.

The authors describe the techniques that use the principles of fat grafting to allow them to successfully graft megavolumes (250-ml range) of autologous fat into breasts. The Brava external volume expansion device preoperatively increases the volume and vascularity of the recipient site. Low-pressure liposuction and minimal centrifugation are used to gently extract and purify the adipose tissue with minimal trauma.

Aesthetic applications of Brava-assisted megavolume fat grafting to the breasts: a 9-year, 476-patient, multicenter experience.

Background: Autologous fat grafting to the breasts was banned in 1987 because of unpredictable graft retention and cyst formation that could not be differentiated from cancer. Surgical and radiologic advances induced a lifting of the ban in 2009. Small- to moderate-volume autologous fat grafting to the breast has become common.

Megavolume autologous fat transfer: part I. Theory and principles.

This article describes the theory and principles behind the authors' success in megavolume (250-ml range) autologous fat transfer to the breasts. When large volumes are grafted into a tight space, the interstitial fluid pressure increases to impair capillary blood flow and the crowded graft droplets coalesce into lakes, with poor graft-to-recipient interface. These factors have historically restricted the volume of fat that can be grafted into small recipient breasts.

Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study.

Background: Breast augmentation by autologous fat transfer is an appealing alternative in need of scientific validation.

Methods: In a prospective multicenter study, 81 women (age range, 17 to 63 years) wore the Brava device, a bra-like vacuum-based external tissue expander, for 4 weeks and then underwent autologous fat injection using 10 to 14 needle puncture sites into each breast in a three-dimensional fanning pattern (average, 277 ml volume injected per breast). Patients resumed Brava wear within 24 hours for 7 or more days.