Fat grafting for the breast

Various fat grafting techniques for breast surgery have been proposed, but some have their critics. One viable alternative to standard liposuction is tissue liquefaction technology (TLT), as embodied in the HydraSolve Lipoplasty System (Andrew Technologies LLC; Irvine, Calif.).

By removing the fat with HydraSolve, the operating surgeon may be able to minimise the intermediate step of processing the fat for reinjection by effectively washing and separating the fat cells at the time of harvest,” says Terence M. Myckatyn, MD, professor of plastic and reconstructive surgery at Washington University School of Medicine in St. Louis, Mo.

Unlike competing technologies that rely on heat or a water jet to process fat, HydraSolve synergises water with heat to efficaciously separate the fat cells with minimal trauma, according to Dr Myckatyn.

After processing, “the fat is very clean, in tiny parcels, and ready for reinjection,” Dr Myckatyn tells Cosmetic Surgery Times. “The actual clumps of fat are smaller than with other forms of liposuction and fat grafting. This translates into a smoother, easier reinjection back into the patient.”

In 2012, HydraSolve became the first FDA-approved liposuction device for fat grafting. Dr Myckatyn is co-author of a retrospective chart review in Aesthetic Plastic Surgery that involved 136 consecutive breast reconstruction patients, nearly all for either cancer or prophylaxis for cancer prevention, who underwent fat harvest with HydraSolve, for a total of 237 procedures (mostly bilateral).

The abdomen was the donor site for 50 percent of the cases, with the remaining two sites being the flanks and the thighs. The overall complication rate for the study was 29 percent, with roughly 75 percent of adverse events due to fat necrosis at the recipient site. “I believe our results are on par with standard liposuction,” says Dr Myckatyn, whose practice group since 2014 has used HydraSolve on about 350 patients, the vast majority for breast reconstruction.

Beyond breast reconstruction, Dr Myckatyn and his colleagues have started using HydraSolve for cosmetic breast augmentation and buttock augmentation.

Kamran Khoobehi, MD, FACS, director of aesthetic training at Louisiana State University Health Science Center in New Orleans, said that the field of fat grafting is rapidly expanding from a minor procedure, with the fastest growing area being the Brazilian butt lift.

“The main concern for most plastic surgeons is the predictability of fat grafting results,” Dr Khoobehi tells Cosmetic Surgery Times. “There are many techniques to harvest, process and inject fat; and most surgeons are looking for a more standardized process to achieve consistent results.”

Source: Cosmetic Surgery Times