Medical Research Evidence & Articles on Fat Grafting Techniques and Autologous Fat Transfer to Breasts
Here is a collection of Medical Articles on Fat Grafting to Breasts (also called Fat Transfer to Breasts), Autologous Fat Grafting or Natural Breast Augmentation.
Fat Grafting is now being used in conjunction with Breast Implants for a Hybrid Augmentation or Composite Augmentation that has better contour results and cleavage lines than implants alone.
There is now ample evidence for the medical benefits of using Fat Grafting and Fat Transfer – Autologous Grafting for Reconstructive and Aesthetic Improvement. Medicare will be adding some new item numbers for the use of Fat Grafting in November 2021.
World Fat Grafting Experts
These are some of the surgeons and researchers that have contributed to use of Fat Grafting for Breasts
- Dr Sydney Coleman
- Dr Roger Khouri
- Dr Gino Rigotti
- Dr J. Peter Rubin
- Dr Emmanuel Delay
Information about Fat Grafting to Breasts by Dr Rebecca Wyten Specialist Plastic Surgeon and fat grafting expert in Melbourne, Australia
- Visit the Fat Grafting to Breasts Procedure Page
- See Before and After Photos of Fat Grafting Patients of Dr Wyten
- Read the Blog on Fat Grafting vs Breast Implants
- Read the Blog on Fixing Uneven or Lopsided Breasts with Fat Transfer
Medical Articles on Fat Grafting (Latest to Oldest)
2021 – Lactation History Affects Postoperative Fat Volume Retention Rate in Autologous Fat Grafting Breast Augmentation
- Original Article
- Published: 25 March 2020
A retrospective study was made to compare the fat volume retention rate in patients who have had different lactation histories. There were two groups: one with a history of lactation and the other without a history. Group A, which consisted of women who have no history of lactation, had 40 patients while group B, who had a history of lactation, had 30 patients.
There were significant differences between the two groups, with a higher postoperative volume retention rate among the patients with a history of lactation. But other factors might be the reason why the rate is higher, which is why the authors suggest further studies on this matter.
Summary: With a need for more research, the authors have formulated the idea that there is a higher volume retention rate after breast augmentation using autologous fat.
2020 – Ex vivo-expanded autologous adipose tissue-derived stromal cells ensure enhanced fat graft retention in breast augmentation: A randomized controlled clinical trial
Published: 2020 Nov
This study is a clinical trial experiment that compared fat grafts enriched with ex-vivo expanded autologous adipose-derived stromal cells (ASCs) and non-enriched fat grafts. Volume retention was measured using magnetic resonance imaging while clinical photographs were taken at the same time for outcome evaluation.
There was a higher retention rate for the ASC-enriched fat grafts compared to the conventional fat grafts. The clinical images demonstrated superior outcomes that were evaluated by independent clinical experts, demonstrating that using culture-expanded ASCs in reconstructive and cosmetic volume reconstruction can be a viable alternative to traditional fat grafting.
Summary: Using ASC-enriched fat grafts can give the grafts a higher retention rate and eventually become a better alternative instead of conventional fat grafting.
2019 – Fat Grafting and Breast Augmentation: A Systematic Review of Primary Composite Augmentation
Published: July 2019
This study led by Dr. Salibian focuses on current evidence on patient selection, surgical techniques, and assessment of the outcomes of composite breast augmentation. It is a systematic review of different studies that are based on the level of evidence, surgical techniques, complications found post-operation, and additional outcomes. 4 case series and 1 retrospective cohort study were reviewed, with a total number of 382 patients.
A trend toward subfascial implant placement and low grafting volumes was found when having a primary composite breast augmentation. To further prove this point, there is a need for long-term studies that analyzes the additional outcome measures.
Summary: When taking a primary composite breast augmentation, there is a chance of having to have a subfascial implant placement as well as low grafting values.
2020 – Comparison of adipose particle size on autologous fat graft retention in a rodent model
Published: 27 Feb 2020
Recent studies show that the size of fat particles is closely related to the fat graft healing outcomes– though there is a chance that certain variables such as tissue trauma during fat harvest can unintentionally affect the said outcome. To test this, the authors decided to compare autologous fat grafting outcomes with variable fat that was particle-sized found in an animal model. The main purpose of the study was to determine if decreasing the fat particle size would be an effective method in enhancing graft retention in autologous fat grafting.
Four common liposuction cannulas were used to harvest the fat particles to quantify and define the relevant small and large particle target diameters. Their nutrient and oxygen permeability was tested by incubating the particles in vitro inside a spinner flask. Weight and volume retention were evaluated at a 4-week interval up to 12 weeks. The authors concluded that there was not much difference in results with different fat particle sizes, as they can achieve similar graft retention.
Summary: Similar graft retention can be found within different fat particle sizes, though it should be noted that they should be large enough to contain enough mesenchyme and be not too thick.
2020 – AN OVERVIEW OF FAT GRAFTING TECHNIQUES
Published: May 22, 2020
Fat in our body is known to be an ideal filler for the human body and face when there is a need for soft tissue augmentation. It is known that fat can be harvested easily, repeatedly, and cost-effectively, which is why there are many advances and refinements on the fat grafting technique. The different techniques of fat grafting can be categorized in the following: 1) harvesting autologous fat, 2) process the harvested lipoaspirate cells, 3) preparing the recipient site, and 4) injecting the fat into small parcels in a specified way. These are all discussed further on the website, along with a more detailed description of each category.
Summary: There are different techniques for fat grafting, and there are four ways to categorize them: harvesting the fat, processing them, preparing the site before injecting the fat in small portions.
2020 – Fat Grafting to Improve Results of Facelift: Systematic Review of Safety and Effectiveness of Current Treatment Paradigms
Published: 07 January 2020
The purpose of the study is to review the efficacy and complication rates of having a facelift procedure with lipofilling compared to having the facelift done alone. It uses clinical reports that used fat grafting combined with facelift surgery, or research with keywords related to the two procedures. There were 248 articles identified for the review, but only 15 primary studies were included in the study. Different facelift techniques were reported, with deep-plane or sub-superficial musculoaponeurotic system facelift, and other similar techniques.
The authors concluded that the addition of the fat grafting technique to a facelift surgery gave significant improvements in facial volume and aesthetic assessments. Not only is it safe, but it can also help with age-related ptosis and volume loss. Though further research is needed to validate and improve the existing treatments.
Summary: Combining fat grafting with a facelift can give wanted results and more, as it provides
2019 – The use of autologous fat grafts in breast surgery: A literature review
Published: Nov 15 2019
As of now, there are multiple studies regarding fat grafting being used in breast surgery. It is known that it can be used to correct uneven breasts and that it is a safe procedure to do. X-ray images found on patients who have had a breast augmentation with fat grafting tend to confuse doctors, mistaking it as breast cancer when it isn’t. There are no enhanced risks on these patients, and recent studies are starting to prove that fat grafts can replace breast implants in the future.
Though fat grafting in postmastectomy breast reconstruction is a different story, more information is needed to claim that the procedure is reliable and safe. There is still no clear judgment of this procedure’s relationship with the study of tumors. Pluripotent stem cells found in the body can be found to contribute to existing cancer cells. When adipose tissue-derived stem cells (or ADSCs) are added to the fat grafts, it may disrupt the microenvironment and stromal-epithelial interactions found in the breasts. A need for more controlled postoperative studies with longer follow-up periods will help these studies immensely.
Summary: Fat grafting in breast surgery is a safe procedure, yet fat grafting on postmastectomy breast reconstruction requires more postoperative studies for it to be considered as a safe procedure.
2019 – The role of fat grafting in prepectoral breast reconstruction
Published: February 2019
A promising alternative to submuscular implants is prepectoral breast reconstruction because it gives the patient a lower risk for pain, muscular impairment, and even animation deformity. Though the thinner the amount of the overlying tissue in prepectoral reconstruction is known to give a “rippling” deformity in some patients, it can be corrected using fat grafting. This study focuses on finding out the recommended technique to use for fat grafting in the prepectoral implanted patient.
Previously the prepectoral approach was discarded as it had an unacceptably high complication rate. There were also lower efficacy rates for concealing implant rippling, but modern generation expanders and implants, as well as the use of acellular dermal matrices and other similar techniques, have been introduced as a result of recent advancements in surgical technique and technology.
Summary: The prepectoral breast reconstruction method used to be a promising alternative, but because it can give a “rippling” deformity, the idea was scrapped until the use of fat grafting could fix it.
2019 – International Expert Panel Consensus on Fat Grafting of the Breast
Published: 2019 Oct
Autologous fat grafting has a wide range of applications within reconstructive and aesthetic breast surgery, for the main reason that it is a natural filler and can regenerate after a certain amount of time. But since there is no shared consensus for the optimal fat grafting technique, the authors of the study decided to hold an organized Survey and International Consensus Conference last 2018 to conform and discuss which are the best methods to use in fat grafting.
There were 10 key statements prepared by the authors that were formed during their review of several studies on fat grafting. These key statements will then be discussed in the meeting, along with a survey to determine how much of the panelists agreed on the statements. The survey had a diverse opinion based on technique between the panelists, with a recommendation to have more evidence-based clinical practice on using fat grafting in aesthetic and reconstructive breast surgery as there are only several studies.
Summary: Despite having several studies on fat grafting, there is still a need to do more evidence-based clinical practice so that there will be a clear consensus on the most efficient fat grafting technique.
2019 – An Overview of Principles and New Techniques for Facial Fat Grafting
Published: October 2019
Fat grafting is a well-known procedure for reconstructive or cosmetic purposes around the world because it is minimally invasive, it comes from rich sources and it is easy to harvest. The unsatisfying retention rate after fat grafting led to unpredictable outcomes, subsequent multiple procedures, and even complications. Because of this reason, several established surgical principles and many possible new techniques have been proposed and reviewed to enhance the results of facial fat grafting. The study concluded that the addition of stem cells, fat preparations, and platelet concentrates may improve survival after fat grafting, but this still needs randomized controlled clinical studies to determine their safety and efficacy, along with the clinical indications for each technique.
Summary: Adding stem cells, fat preparations, and platelet concentrates may improve survival after fat grafting, but further controlled clinical studies are necessary to determine the safety and efficacy of each technique.
2018 – For Better Fat Graft Outcome in Soft Tissue Augmentation: Systematic Review and Meta-Analysis
Published online: October 30, 2018
This meta-analysis conducted in 2018 examined the literature on the survival rate of autologous fat grafts using objective markers and identify variables that influenced the survival rate. The researchers reviewed the EMBASE, PubMed, and Cochrane Library databases from January 2001 to December 2017, which included a total of 27 studies (1,066 cases). The meta-analysis had several conclusions: the survival rate was significantly higher in patients who underwent breast pre-expansion using the BRAVA device, procedures performed to correct lipoatrophy was higher than that of procedures performed for other purposes, and that there were no significant differences in the survival rate according to the recipient site, harvesting method, or refinement method.
Summary: A meta-analysis was performed to estimate fat graft survival and investigated the factors that affected the survival rate.
2018 – Gentle is better: The original “gentle technique” for fat placement in breast lipofilling
In a retrospective cohort study led by Gentile P. and others in 2018, 120 patients that were affected by breast soft tissue defects were studied. Half of the patients were managed with the lipofilling procedure using fat graft injected by the “Gentle technique,” while the other half was treated with fat graft injection according to Coleman procedure. It has been found that patients treated with the Gentle technique observed a 60.5% + 12.5% maintenance of contour restoring and three-dimensional volume after 1 year, which was then compared to the results obtained with only 39% + 4.4% of the control group treated with fat graft injected according to the Coleman procedure. Because of the focus on the last stage of fat grafting by the Gentle technique, any unnecessary manipulation of the graft has been eliminated and in return optimizes the graft retention and clinical outcomes. It has been concluded that controlled movement and slow speed of fat injection, the cornerstone of the procedure, can guarantee a nontraumatic fat transfer and a greater survival rate of adipocytes.
Summary: The Gentle technique has been proven to have a greater survival rate of adipocytes because of the focus on controlled movement and slow rate of fat injection.
2018 – Autologous fat grafting: Harvesting Techniques
Published online 2018 Nov 13
The research made by Tomás Fontes and company focuses on the following: finding out where is the best donor-site, the differences between the existing harvesting techniques (such as the tissue resection, hand aspiration, and liposuction techniques). As well as the recommended pressure application, harvesting cannula diameters, and volume of wetting solution injected before the aspiration. Through these, the “best” method for harvesting autologous fat grafts should be made. But since the techniques each give a varying result for different criteria, it makes it difficult to compare them with each other and point out which technique will be considered as the “most efficient”.
Summary: There is no uniform methodology for fat grafting as of now because there is an absence of standardized guidelines for harvesting them.
2018 What is the current optimal fat grafting processing technique? A systematic review
Published: Feb 2018
35 studies were systematically reviewed, utilizing the databases of PubMed, Embase, Cinahl, and Cochrane that were dated until August 2015. Studies showed that the gauze/towel technique (permeability principle) had the best outcome regarding adipocyte viability and ASC numbers compared to centrifugation (reinforced gravity principle). However, none of the processing techniques in this study demonstrated significant clinical evidence.
Summary: Adipocyte viability and ASC numbers were best using the gauze/towel technique in comparison to centrifugation, but no processing techniques in the study provided any clinical evidence superiority.
2018 – Proposed Methods to Improve the Survival of Adipose Tissue in Autologous Fat Grafting
Published: August 2018 – Volume 6 – Issue 8 – p e1870
Mark Landau and company have made a review study on the basic science of fat grafting, proposed methods offered to improve the engraftment process as well as the reported outcomes of AFG procedures. This study was made to find out what kind of methods are appropriate for improving the survival of adipose tissue in autologous fat grafting.
The Platelet Rich Plasma method, also known as PRP is a method where it is a growth factor-rich injectable that can be made quickly. It is also considered cost-effective as it uses the patient’s own blood. Aside from using this method for fat grafting, it is also used for bone regeneration, wound healing, and other similar types of healing or repair. Results may be different because of its different applications, making it harder to compare it with other methods.
The Adipose-derived Stem Cells and Cell-Assisted Lipotransfter method is when the lipoaspirate (which are aspirated adipose tissue) will be used for fat grafting with progenitor cells found in the adipose tissue. It is recommended to harvest excess lipoaspirate and isolate the progenitor cells contained within it since the lipoaspirate is known to be poor in those cells. Many studies show that ASCs have many characteristics that help in retaining fat grafts.
No ideal method has been determined yet, despite having studies focused on using the PRP method, the ASC (Adipose-derived Stem Cells and Cell-Assisted Lipotransfer) method, or both. There is notable anecdotal evidence, but there is a need for more clinical evidence to validate which of the techniques is considered the best one to make certain that there is a volumetric retention of adipose tissue after autologous fat grafting.
Summary: More clinical evidence is needed to find out what method is best to improve the survival of adipose tissue during the autologous fat grafting.
2017 – A systematic review of patient factors affecting adipose stem cell viability and function: implications for regenerative therapy
Published: 2017 Feb 28
The use of fat grafting has increased as of late, in both regenerative and reconstructive surgery. Though several studies focus on how the fat is to be harvested, processed, or injected, the outcome of the fat grafting has little to no impact. The authors suggested that there may be a bigger impact if the patient’s characteristics are applied to the equation. The study aimed to collate recent and current evidence and the effect of patient factors on adipocyte and ADSC (adipose-derived stem cells) behaviour.
41 reviews were included in the review, with evidence that states a decrease in proliferation and differentiation potential of ADSCs as their age increases. Other factors such as body mass index, diabetes mellitus, and exposure to radiotherapy and Tamoxifen were mentioned as well, but not in all studies. Circulating oestrogen levels seemed to show support on both adipocyte function and graft viability.
Summary: There are not many significant factors related to the patient that could affect adipocyte and ADSC viability, but future studies that focus on adipocyte viability may help in coming up with a better and meaningful conclusion.
2017 – Autologous Fat Transfer for Facial Rejuvenation: A Systematic Review on Technique, Efficacy, and Satisfaction
Published: 2017 Dec 22
The study is a systematic review that aimed to assess available evidence about the safety and effectiveness of Autologous fat transfer (AFT) for rejuvenation of the face. AFT can be used as a dermal facial filler, even proving to have real potential because of the biocompatibility of the adipose tissues. Case series, cohort studies, and randomized controlled trials (RCT) that had suitable outcomes for the studies were included.
As there are different variables and results in the studies, AFT seems to be a hopeful prospect in techniques in facial rejuvenation with fewer complications compared to other fillers and high patient satisfaction rates. There is a need to process the results of the articles found in the study, through quantifiable volumetric assessment tools while following predetermined nomenclature in terms of complications.
Summary: This is a systematic review that suggests the use of AFT for dermal facial fillers, as it provides fewer complications and higher satisfaction rates for patients.
2017 – The procedure, applications, and outcomes of autologous fat grafting
Published: August 2017
This study aimed to systematically review the different procedures, applications, and outcomes of fat grafting. It starts with mentioning fat harvesting and the different techniques that have been proposed to do it effectively and efficiently. After that, the study mentions the different techniques for processing the harvested fat, along with how lipoaspirate and other factors can affect that fat. The fat injection procedure is then discussed, though there are no preferred or effective techniques as of now. The roles of ASCs are discussed as well, along with how these help the process of autologous fat grafting. Different applications of fat grafting are also mentioned, such as breast reconstructive surgery and the like.
Lipofilling is known to have filler and regenerative effects that are used in different types of plastic surgery despite having limitations such as a relationship between the number of adipose tissues and the fat grafts. More research that focuses on lipofilling in tissue engineering and ASCs will help figure out the other uses or benefits of lipofilling.
Summary: The study is detailed research about how fat grafting is prepared, done and the different techniques that can be used in the procedures. More research on lipofilling is recommended as it has regenerative and filler effects on the affected area.
2017 – Mammographic Changes After Fat Transfer to the Breast Compared with Changes after Breast Reduction: A Blinded Study
Published online 2017 Oct 18. Prepublished online 2017 Jun 28.
This study examined 27 female patients with normal preop mammograms who underwent stem cell enhanced autologous fat grafting and had a mammogram 12 months after their operation. Each mammogram was read by 8 independent radiologists who have discovered that post-operative mammography produced higher rates of scarring, oil cysts, benign calcifications, and distortion warranting biopsy in the breast reduction group while the breast grafting group had a higher rate by 3.6% for calcifications warranting biopsy. It has been concluded that fat grafting of the breast resulted in lower rates of mammographic abnormalities compared to the accepted procedure of breast reduction surgery.
Summary: Patients who have undergone breast reconstruction and fat grafting noticed a significant improvement in breast satisfaction, psychosocial and sexual well-being.
2016 – Current Thoughts on Fat Grafting: Using the Evidence to Determine Fact or Fiction
Published: 2016 Mar
This study conducted an evidence-based review to determine the fact from fiction regarding the hot topics in autologous fat grafting. After a comprehensive literature search of keywords such as “fat grafting”, “lipotransfer”, “autologous fat transfer”, and other related terms, the authors found that there is no standard test for determining the fat viability or volume augmentation after the fat grafting process.
There is also no difference between syringe aspiration and liposuction pump aspiration harvest techniques when it comes to cell viability and harvest location. Having the fats washed or centrifuged hardly does anything in terms of fat graft survival. There is barely any effect of local anesthesia on adipocyte cells while there is quality evidence to support the longevity of the fat grafting to the breast and the idea that the fat should be injected right after harvesting because the properties of the fat tend to change after processing. Other studies they found showed that there was an improvement in the total graft survival rate if microneedling was done before the fat grafting as well as using an external pre-expansion device.
Summary: After evaluating a series of studies regarding fat grafting, the authors found out that using microneedling and external pre-expansion devices can improve the survival rate of the fat grafts.
2015 – Post Mastectomy Fat Graft/Fat Transfer ASPS Guiding Principles
Published online 2017 Oct 18
In 2015, the American Society of Plastic Surgery Fat Grafting Task Force (ASPS) released a consensus opinion on Post Mastectomy Fat Graft/Fat Transfer. It has been concluded that there is a consistency in outcomes when the fat is transferred into a mastectomy and that there is an improvement in post-mastectomy syndrome after the fat graft is done. The majority of the patients see an improvement in the aesthetic aspect and require more than 1 session to be satisfied with their result. It was also discovered that radiation therapy does not increase the complication rates of fat transfer to sites where mastectomy was performed, and rather the complication rate is related to the surgical technique used. There was also no increase in breast cancer recurrence after performing fat transfer to a mastectomy site.
Summary: When fat is transferred after a mastectomy, there is a noticeable improvement in terms of the aesthetic aspect after getting a fat graft procedure.
2015 – Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience
Published: 29 Dec 2015
Women have experienced chronic pain after having breast surgery, specifically 25 to 60 percent of patients. This condition is named Postmastectomy Pain Syndrome (or PMPS) and is found to be at the upper part of the body and is felt more than 3 months after the mastectomy or quadrantectomy surgical procedures. 209 patients who have undergone either a mastectomy or quadrantectomy were selected. And out of these 209 patients, 78 of them were diagnosed with PMPS and have not been treated yet to be considered as the control group.
One of the notable effects of surgical treatments is persistent pain, and the cause of this continues to be unclear. Pain decreases in the treatment of several forms of neuropathic pain using fat graft have already been proven in several studies. Aside from that, the fat grafting procedure is also proven to be safe, efficient and gives optimal tolerability based on experience and research– which is why fat grafting is supported by the authors of this study.
Summary: There is still no clear reason or cause of the condition Postmastectomy Pain Syndrome (or PMPS) but the process of fat grafting is proven to safe and efficient.
2015 – A Case Controlled Study of the Oncologic Safety of Fat Grafting
Published: 2015 May;135(5):1263-1275.
Complete data from 211 out of 328 patients who had fat grafting after breast cancer was gathered in May 2015. The average follow-up was 32 months after fat grafting and 4.5 years after breast cancer surgery. Coleman technique was used for the procedure without the use of stem cell or growth factor enhancement, with an average of 1.28 procedures on a scale ranging from 1-4. There were no statistically significant cancer events that were noted regarding local, regional, or distant recurrences. However, a systematic review reveals that there is a locoregional recurrence rate of 0.95% per year after fat grafting in breast cancer surgery.
Summary: There is no evidence of oncologic risks related to women who have undergone fat grafting after being treated for cancer.
2015 – Best way to prepare fat cells for grafting? Jury’s still out
Published: September 28, 2015
According to ASPS Member Surgeon Alexes Hazen, MD., The updated review in the October 2015 issue of Plastic and Reconstructive Surgery® finds no “compelling evidence” to recommend any single technique as the best method for processing harvested fat cells for fat grafting. Although several techniques have been shown to successfully isolate the stromal vascular fraction and can be deemed viable methods of fat processing, further research is needed to compare the outcomes of current methods and evaluate promising new techniques.
Summary: Available research data still can’t settle that long-running debate regarding the best way to prepare fat cells for grafting, according to a review in the October issue of Plastic and Reconstructive Surgery® – the official medical journal of American Society of Plastic Surgeons (ASPS).
2015 – The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques
Published: 2016 Oct 1.
Published in final edited form as:
Studies that explore the effects of processing techniques, harvesting procedures and reinjection methods based on the survival of fat grafts are highlighted in this research. It focuses on the different techniques that have different outcomes on the following: vitro analyses, vivo animal experiments, and human studies.
Results show that there are no significant differences with the outcomes of fat grafting obtained from different options such as donor site preparations, harvest technique, fat harvesting cannula size, and even centrifugation speed when the solution was used. There is a difference in gauze rolling though, which is found to enhance the volume of the grafted fat while higher retention was observed when there is a slower reinjection speed and introduced into less mobile areas.
Summary: Even though there are no significant differences between the harvest technique and the different preparations, there is one when it comes to using a certain gauze rolling or having a slower injection speed placed at less mobile areas.
2014 – Autologous fat transfer for cosmetic and reconstructive breast augmentation ASERNIP-S
Published: Epub 2013 May 8.
Thirty-five studies have been reviewed and systematically reviewed. Several of them were randomized controlled trials, others were single arms that were extracted, while the others were either case series studies or reported outcomes for autologous fat transfer. The other literature available was deemed as poor quality, with the lack of comparative evidence necessary to make the needed conclusions to compare autologous fat transfer with cosmetic and reconstructive comparator procedures. Commonly reported complications found with the autologous fat transfer were fat necrosis, calcification, and cysts. It should be noted that only a small percentage of patients have experienced these complications and that nothing is linking the presence of the complications with long-term mammographic or cancer-related outcomes.
Summary: It is safe to have an autologous fat transfer along with other augmentative procedures.
2014 – Differential fat harvesting
Published: 12 Mar 2014
Sixty patients who have undergone a facial fat grafting procedure in a private practice setting between March 2012 and October 2013 were studied. Differential harvesting was performed, with the outcomes analyzed by both the physicians and the patients at 7 days, 1 month, 3 months, and 6 months through a satisfaction survey. The full facial differential fat grafting procedure has an average downtime of 3 to 4 days which lasts for an average of 1.5 to 2.5 hours. A follow-up was performed after 6 months, wherein both the patient and physician’s overall satisfaction rates were predominantly excellent. No adverse events like lumps or irregularities were encountered.
Summary: Differential fat harvesting and posterior grafting is a viable alternative to allow a more homogeneous effect, improve graft survival, expand the repertoire of fat use, speed up the process, reduce the potential complications, and enhance the overall aesthetic outcome.
2014 – Studies in fat grafting: Part I. Effects of injection technique on in vitro fat viability and in vivo volume retention
Published: 2014 Jul
A technique that has become popular in correcting soft-tissue deficits is fat grafting, though the long-term outcomes for this depend on the delivery of the fat. If it is delivered in a way that involves the least trauma, it means that the viability was optimized for the transplanted tissue. For this study, the authors compared the biological properties of the fat that followed two methods of injections.
Five females donated their lipoaspiration samples that then had their cellular viability, proliferation, and lipolysis analyzed or evaluated. There were comparisons made between these samples and minimally processed fat. Results showed that the fat viability and cellular proliferation were notably greater with the Adipose Tissue injector compared to the modified Coleman technique. Greater histologic scores were found for healthy fat while injury that followed injection with the device showed lower scores.
Summary: The placement of fat and the techniques can show how the injected tissues are affected through the biological properties of injected tissues. The studies showed that using automated low-shear devices would increase fat viability.
2014 – Studies in fat grafting: Part II. Effects of injection mechanics on material properties of fat
Published: 2014 Jul
Since fat grafting findings are still ambiguous, the authors of this study decided to compare the physical properties of the fat following injection using two options: an updated Coleman technique or an automated and low-shear tool. This study is a second part of the research for fat grafting where the authors focus on the effects of certain injection mechanics on the different material properties of fat.
Fat injected through an automated, low-shear device was found to be closely matched with the physical properties and viscosity measurement of the minimally processed fat. The use of the automated device also showed a more preserved intactness of the fat compared to the modified Coleman technique. So based on the results, there is less damage to the fat if the automated device is used, therefore potentially supporting its use for the integrity of the fat graft.
Summary: Using the automated low-shear device can provide less damage to the fat, keeping the integrity of the fat graft.
2014 – Experimental and clinical methods used for fat volume maintenance after autologous fat grafting
Published: 2014 Apr
Fat grafting is a technique that is used in correcting facial asymmetry where the aesthetic procedures use the grafted fat for soft tissue augmentation and recontouring. Therapeutic modalities used in fat grafting are found to be crude and unpredictable, often disapproving once approved hypotheses.
Soft tissue deficits that resulted from trauma, systematic disease, and other similar cases are found to be a challenging field for plastic and reconstructive surgery. The study aimed to present recent evidence regarding experimental studies that either confirmed or disproved the theories of fat volume expansion and fat maintenance after autologous fat grafting.
Summary: This study contains the most recent evidence that focuses on experimental studies and designs that could either confirm or disprove fat volume expansion theories after autologous fat grafting.
2014 – Aesthetic Applications of Brava Assisted Megavolume Fat Grafting to the Breasts: A 9-year, 476 patient multicentre experience
Published: 2014 Apr;133(4):796-807.
A study on 476 patients in 9 years between 2 hospitals was conducted in April 2014. It has been recorded that there had been 565 sessions in total, with 73 patients having 2 procedures and 8 patients having 3 procedures – most of which were seen in the implant to fat conversion patients. The average age ranged from 16-60, with the mean of 37.6, while the BMI average ranged from 16.2-29.2 with a mean of 21.6. The criteria excluded smoking, excess bleeding tendencies, unrealistic expectations, and multiple prior liposuction procedures that decreased the available fat to transfer. The case featured 294 patients for aesthetic breast augmentation, 88 patients that had an implant to fat conversion without Brava, 45 patients for congenital deformity, 43 patients for complication correction, and 6 patients for implant-fat conversion.
Summary: A safe and effective alternative for breast augmentation and deformity correction after implant removal is the use of large-volume autologous fat grafting.
2013 – Comparison of Three Fat Graft Preparation Methods: Centrifugation, the Lipokit™ System, and the Cytori Puregraft® System
In this 2013 study by Min Zhu and company, adipose tissue from six donors (one male and five females) was acquired from the subcutaneous abdomen, flank, thigh, and back adipose tissue depots using vacuum-assisted suction. Results revealed that Centrifugation, the Puregraft System, and the Lipokit System all successfully reduced the amount of aqueous fluid in grafts compared to the unmanipulated control group. However, the Puregraft System significantly outperformed all the other approaches in terms of red blood cell content and reducing free-lipids. It can also simultaneously produce graft with significantly higher adipose tissue viability. Because of the integrated design of the Puregraft System, it is the only system among the other systems that allow graft preparation within the sterile field without exposing the fat graft to the open environment and the users to potentially biohazardous material.
Summary: Among the three methods, the Puregraft System consistently outperforms the other approaches evaluated in all key parameters, which further confirms that this increased performance leads to improved clinical performance is being evaluated in continuing clinical studies.
2013 – Platelet Rich Plasma (PRP) Improves Fat Grafting Outcomes
Published: January 2013
A study by Ali Modarressi proposed the addition of autologous platelet-rich plasma (PRP) to fat grafts to improve fat cell survival. PRP is known as a natural reservoir of growth factors stimulating tissue repair and regeneration. The approach is completely autologous and employed almost immediately without any type of preconditioning. Vitro studies had demonstrated that PRP can increase the fat cells survival rate and stem cell differentiation, while animal models showed that the fat graft survival rate was significantly increased by adding PRP. It has also been confirmed by several clinical cases that there is an improvement of wound healing and fat grafting survival in facial reconstruction and aesthetic cases by the association of fat grafting with PRP. In conclusion, the addition of 20% PRP to fat grafts offers a better fat grafting survival, easier application of fat grafts, and less bruising and inflammatory reaction due to the liquefaction effect of PRP.
Summary: The addition of autologous platelet-rich plasma (PRP) can to fat grafts to improve fat cell survival, easier application of fat grafts, and a less bruising and inflammation reaction due to liquefaction effect of PRP.
2013 – Supplementing fat grafts with adipose stromal cells for cosmetic facial contouring
Published: 2013 March
No definitive treatments are currently available to enhance the survival of the fat grafts, though several methods were proposed. One of them, the stromal vascular fraction (or SVF)-assisted cell therapy offers a new angle on improving the survival of these fat grafts. 26 women who have undergone fat transplantation with SVF and 12 women who had fat grafting alone were considered. Each of these women had computed tomography and was photographed before the surgery and 6 months after the surgery.
There was a higher fat survival and better clinical improvement when the patients had SVF along with fat grafting. It can also provide satisfactory outcomes without major complications. These are still not enough and would need more studies on it before concluding a definitive method of fat processing that will ensure maximal graft take and viability.
Summary: Stromal vascular fraction-assisted cell therapy is proven to have higher fat survival and better clinical improvement compared to having a fat grafting procedure only.
2013 – Magnetic Resonance Imaging & Ultrasound Evaluation after Breast Autologous Fat Grafting with Platelet Rich Plasma
Published: 2013 Oct;132
A study led by Fiaschetti and company was conducted on 15 women who underwent a lipofilling procedure for corrective surgery or cosmetic procedures. Breast lipofilling is a reconstructive and aesthetic technique where a patient’s fat cells are transferred to fill or increase areas where there is a lack of volume on the breasts. The procedure requires two sessions with a gap of 3 to 6 months in between each session where they used mammography, ultrasound, and magnetic resonance imaging before and after each operation to note the radiologic findings around the breasts.
The study found that oil cysts found using an ultrasound scan has a scan rate of 70% but decreases with time. While MRI, at same time intervals, reported oil cysts at 8% (or 2 out of 24 breasts). It is important to note that fat necrosis greater than 20mm diameter rates were found to be stable 3 months after the first fat grafting session. These are increased slightly with time. Microcalcifications were found in 20% of patients with volumetric assessment showing an average of 30% volume loss at 12 months and 15% at 6 months. If patients are checked regularly after the operations, post-lipofilling breast changes can easily be differentiated from malignant alterations.
Summary: Changes in the breasts after having a lipofilling can be easily differentiated from malignant transformations if there are regular checkups (especially magnetic resonance examinations).
2012 – Importance of mesenchymal stem cells in autologous fat grafting: a systematic review of existing studies
Published: 2012 Apr
Autologous fat grafting or lipofilling ensure repair and augmentation of the soft tissues and is used in both aesthetic and reconstructive surgery. The technique has advantages such as biocompatibility, versatility, natural appearance as well as a low donor site morbidity. Several studies are trying to find new ways of increasing the viability of the transplanted tissue, mostly to decrease the chances of ischemia or lack of neoangiogenesis.
One approach that is considered promising is the use of enriching fat grafts with adipose tissue-derived mesenchymal stem cells (or ASC) before transplantation. The authors have reviewed original studies regarding fat transplantation with ASC. There were four murine and three human studies that showed significant differences among each of the studies, making ASC-enriched lipofilling theoretically has the potential of transforming the fat grafts from an unpredictable intervention into one where the resorption rate, quality of the tissue, and safety can be better than prosthetic implantation.
Summary: Using ASC-enriched lipofilling can hypothetically transform lipofilling to a more predictable type of cell by expecting the values of the resorption rate, quality of the tissue, and the safety of these cells.
2012 – Brava and Autologous Fat Transfer Is a Safe and Effective Breast Augmentation Alternative: Results of a 6 year, 81 patient, Prospective Multicenter Study
Published: 2012 May; 129(5):1173-1187.
This study conducted by Khouri in March 2012 examined the results of 81 patients in 6 years. The patients wore a BRAVA device for 10 hours per day, 4 weeks before their operation, and more constantly for the last 36-48 hours. A Lipografter was used for harvesting and processing the fat while utilizing the microdroplet technique for fat placement. After which, the BRAVA device was replaced within 24 hours for 48-72 hours uninterrupted, then used at night for 4 more days. Results showed an average grafted volume of 282ml with a 78% graft survival rate, which was followed up for an average of 3.7 years. 3- and 6-month MRI results were essentially unchanged, proving the stability by 3 months. It was then discovered that 16% of the patients (12 women) had visible fat necrosis on MRI, and these were the only patients with calcifications on mammography at 1 year, but the calcifications were recognizable as benign fat necrotic foci.
Summary: Adding a Brava expansion before getting an autologous fat grafting can effectively help patients with larger breast augmentations, specific fat placement, and high safety.
2011 – The Oncologic Outcome and Immediate Surgical Complications of Lipofilling in Breast Cancer Patients: A Multicenter Study–-Milan-Paris-Lyon Experience of 646 Lipofilling Procedures
Published: 2011 Aug;128(2):341-346.
A study by Petit JY, Delay E in August 2011 examined 3 institutions with 513 consecutive patients (646 procedures) for breast cancer reconstruction using an autologous fat transfer from December 2000 up until March 2010. The Coleman technique was used for harvesting, with low-g centrifuge processing. There was no data collected regarding graft survival. Results showed that 18.1% required more than one fat transfer procedure, with a 2.8% complication rate which is mostly fat necrosis (2.0%) but also included some local infections, seroma, and pneumothorax. It was reported that 9 out of 13 patients with fat necrosis received post-operative radiotherapy in some form. 119 breast-conserving surgery cases had a systematic yearly mammogram follow-up, with 12 post-op mammograms having abnormalities. 7 of which showed benign calcifications, along with 3 suspicious lesions, and 2 benign opacities. Out of the 12, 7 were biopsied while there were 5 benign lesions (2 fat necrosis, 2 scarring, and 1 fibrocystic lesion) and 2 cancer local relapses. The study also concluded that although autologous fat transfer for breast cancer reconstruction has a very low rate of getting complications, as it does not provide definitive proof of the safety of the technique, in terms of having cancer again or distant metastases.
Summary: Getting a lipofilling after a breast cancer treatment has a very low complication rate and has no notable effect on any radiologic follow-ups.
2011 – Breast augmentation using Pre-Expansion and Autologous Fat Transplantation: A Clinical Radiographic Study
Published: 2011 Jun;127(6):2441-2450.
In June 2011, Del Vecchio and others studied 25 patients and 46 breasts from 2007-2009. All patients underwent 3 weeks pre-expansion with Brava device, with their “mega volume” (>300cc) fat transfer processed using low-g force centrifugation. A post-operative ‘splinting’ with Brava on low function begun at 24-48 hours after the operation, which lasted for around 2-4 weeks.
The study compared pre-and 6-month post-operative 3D imaging and MRI to quantify the breast volume, with only 12 patients who completed the protocol. It was found that there is an average of 100% increase in breast volume at 6 months post-operatively, with the range being between 60-200%. The postoperative MRI showed that the increase in breast volume was due to the viable fat cells and that there were no detected new cysts, fat necrosis, or breast masses after 6 months.
Although the fat harvesting technique was not specified, it was stated that the fat was processed using a low-g centrifuge. The study showed that patients had pre-and post-op 3D volumetric imaging or MRI to quantify the breast volume changes. An average of 106% increase in total breast volume was recorded, or 64% graft take.
Summary: Pre-expansion of the breasts can help give long-lasting results in a short amount of time, and it can be used as a common standard for fat grafting strategies.
2011 – Clinical Analyses of Clustered Microcalcifications after Autologous Fat Injection for Breast Augmentation
Published: 2011 Apr;127(4):1669-1673.
A total of 48 patients in Beijing with autologous fat grafting for breast augmentation was studied for over 10 years with mammography at 18-72 months after their operation. An unknown variation of the Coleman technique was used to harvest, process, and reinject the fat. The authors of the study concluded that clustered microcalcifications cannot be distinguished from malignant calcifications and that the method should continue to be prohibited. The paper further discusses the variation in fat grafting technique and radiographic techniques used in comparison to other studies.
Summary: Clustered microcalcifications cannot be distinguished from malignancy, proving that autologous fat injections should stay as a prohibited procedure.
2011 – Adipose tissue grafting to post-mastectomy irradiated chest wall: Preparing the ground for implant reconstruction
Published: 2011 Sep
A study published by Sarfati in 2011 found that fat transfer to the breast improves skin quality, so the procedure was used as an initial stage in breast reconstruction to improve the implant coverage. The study featured 28 patients in 2 years, with fat transfer beginning 6 months after their radiotherapy has ended. It was recorded that the average fat transfer sessions were 2, though some patients had 3. In a range of 4-34 months, the mean follow-up was 17 months with 3 minor complications found. The average volume of injection used was 115cc (range 70-275cc) each time. In terms of cosmetic results, around 80% of cases were rated good to very good by both the patient and the surgical team.
Summary: Getting a fat grafting after an implant placement can help prepare the body for implant breast reconstruction.
2011 – Towards a more rationalized approach to autologous fat grafting
Published: Received 3 June 2011; accepted 21 September 2011
Several studies were critically reviewed by Dr. Pu to identify the best donor sites for fat grafting, along with how the fat grafts should be harvested, processed, and placed. Notably, there is one study that showed that there are more adipose-derived stem cells (ADSCs) found in the fat grafts harvested from the lower abdomen or inner thigh. Better viability can be found in the fat grafts were harvested with syringe aspiration and if it is processed with centrifugation at 1200g for 3 minutes. And lastly, the fat grafts should have a maximal amount of contact with the vascularized tissue of the patient for better survival.
Summary: To choose a more rationalized fat grafting technique, one must need to include the proper selection of the donor site, ensure that there are a proper harvest and process of fat grafts, and lastly, proper placement of the fat grafts.
2011 – Autologous Fat Graft in Postmastectomy Pain Syndrome
Published: August 2011
Postmastectomy pain syndrome (or PMPS) is known to be a common neuropathic pain that usually appears after mastectomy. There is no effective cure as of now, despite numerous studies of this syndrome. This study aims to assess the clinical effectiveness of using the lipoaspirate graft in treating the PMPS. 113 patients were recruited for this study, each of them affected by the PMPS and severe scar retractions. 72 of the patients were treated using autologous fat grafted in painful scars while 41 patients were not treated. There was a pain assessment that was performed using a visual analog scale before and after the treatment, with an average follow-up session of 13 months.
Results of the study show that patients that were treated with autologous fat grafts experienced a significant decrease in pain, with 28 out of 24 patients stopping their analgesic therapy after their follow-up session.
Summary: Autologous fat grafting is a noninvasive, rapid surgical procedure that is proven effective in treating PMPS.
2011 – Radiographic Findings after Breast Augmentation by Autologous Fat Transfer
Published: 2011 Mar;127(3):1289-1299
76 patients from 2000 to 2008 with autologous fat transfer to the breast were studied in March 2011. A total of 113 procedures were performed using a slightly modified Coleman technique for harvesting, processing, and grafting. In a comparison of 20 patients’ preop and post-op mammograms, no significant difference was found between groups in terms of breast density standardized Breast Imaging classification. This means that there is no reason for mammogram analysis to experience difficulties after performing an autologous fat transfer to the breast. This also acknowledges the need for radiology interpretation by a radiologist that has trained in breast surgery radiology.
Results showed that 31 out of 76 patients had their post-op mammograms analyzed within a year after their operation, while the other 45 patients did not meet the inclusion criteria for this part of the study. The results are as follows: 54% had no radiological abnormality, 26% had cystic lesions (likely oil cysts), 16% had benign microcalcifications, 9% had macrocalcifications, and 12% had visible scarring associated with nipple lift scars in the breast.
Summary: After having a fat grafting procedure, it is fine to have a radiographic follow-up of the breasts as it does not affect the body in any way.
2010 – Determining the Oncological Risk of Autologous Lipoaspirate Grafting for Post-Mastectomy Breast Reconstruction
Published: 2010 Aug;34(4):475-80
This study published in 2010 featured 137 patients who underwent fat grafting after a modified radical mastectomy in two distinct time windows. The average follow-up time was 7.6 years, and the study had no control group present. Local and regional recurrence rates were compared to published data from patients who had not had fat grafting after their mastectomy. The study had the following conclusion: “Although further conformation is needed from multi-center randomized clinical trials, our results support the hypothesis that autologous lipoaspirate transplant combines striking regenerative properties with little to no or marginal effects on the probability of post-mastectomy locoregional recurrence of breast cancer.”
Summary: Autologous lipoaspirate transplant has regenerative properties that have little effect on the post-mastectomy locoregional recurrence of breast cancer.
2010 – Autologous Fat Grafts Harvested and Refined by the Coleman Technique: A Comparative Study
Published: 2008 Sep;122(3):932-937.
A lab study by Coleman Pu compared the viability of fat cells harvested and processed using the Coleman technique and conventional liposuction. Viability means the ability to grow or develop under dry conditions and the viability of fat cells is a poorly studied and not well-known topic.
The study was conducted on sixteen adult women where two groups of eight had their fat grafts harvested and processed using the Coleman technique on one and the other group used the conventional liposuction technique. The samples were then analyzed using the trypan blue vital staining for viable adipocyte counts, glycerol-3-phophatase dehydrogenase assay, and a routine histologic examination.
The fat grafts obtained by using the two methods have a normal histologic structure. The grafts that used the Coleman technique yielded a greater number of viable adipocytes, and they sustain a more optimal level of cellular function. Because of this, it is concluded that the Coleman technique should be the new preferred method of choice for fat graft harvesting.
Summary: This lab study focused on comparing the viability of fat cells processed and harvested by the Coleman technique in comparison to conventional liposuction, with the conclusion that the Coleman technique provides around 60% more viable cells than the standard liposuction.
2009 – Current applications and safety of autologous fat grafts: A report of the ASPS Fat Graft Task Force
A total of 111 articles were compiled in March 2008, stating that fat grafting of the breast results is dependent on surgeon expertise and technique. Although fat grafting is a safe technique, the need for sterile conditions still needs to be emphasized. Surgeons should exercise utmost caution when considering autologous fat grafting, especially for patients at high risk for breast cancer. The longevity of graft is still unknown, so additional treatments may be mandatory. Fluctuations in body weight can also affect graft volume over time. The published reports also discussed application, efficiency, risks, and complications that may arise.
Key Summary: The study focused on reviewing the scientific literature and other information available to come up with evidence-based recommendations for fat grafting.
Published: 2009 Jul
2008 – Influences of centrifugation on cells and tissues in liposuction aspirates: optimized centrifugation for lipotransfer and cell isolation
Published: 2008 Mar
Injective autologous fat transplantation is considered to be one of the most attractive options for soft-tissue augmentation, but problems such as unpredictability and fibrosis that come from fat necrosis prevent it from being the best option. Eight healthy female donors donated liposuction aspirates that were either centrifuged or not centrifuged at a variety of weight samples for 3 minutes.
The amount of adipose, oil, and fluid sections, as well as the number of blood cells and adipose-derived cells, were all assessed. Centrifugation at more than 3000g had damaged adipose-derived stem cells, and it enhanced the graft take every 1 ml centrifuged adipose. But there is a reduced calculated graft take per 1 ml adipose before the centrifugation process. The authors of the study recommend 1200g of the liposuction aspirates as the optimized centrifugal force to obtain good short- and long-term results in adipose transplantation.
Summary: The study investigates quantitatively the effects centrifugation has on liposuction aspirates, to find the optimal centrifugal conditions for the fat transplantation and isolation of the adipose-derived stem cells.
2007 – Fat Grafting to the Breast Revisited: Safety & Efficacy
In March 2007, Coleman and Saboeiro published a study that focused on 17 patients with fat grafting to the breast over 5 years. One to three sessions were performed with an average volume of 280cc fat grafted using the Coleman technique. With follow-ups averaging in about 4 years (at least 1 year after the procedure), the mammographic changes are consistent with any type of breast surgery that was performed.
Published: 2007 Mar
Summary: Based on the results and reports, free fat grafting is a good option for breast augmentation and reconstruction procedures.
2006 – Structural Fat Grafting: More Than a Permanent Filler
Published: 2006 Sep;118(3 Suppl):108S-120S.
Coleman published a study in 2006 stating that fat grafting survival is dependent on the technique used. Many surgeons have refined their techniques to obtain long-term results with grafted fat and have observed that transplanted fat also improves surrounding tissues into which the fat is placed. They have also noted the improvement in the quality of aging skin and scars, as well as a significant improvement in conditions such as chronic ulceration, radiation damage, breast capsular contracture, and damaged vocal cords. The Coleman technique resulted in a 90% survival rate.
Summary: The quality of skin and scars have improved after observing that the transplanted fat can help adjust facial and body proportion.
2002 Analysis of lipocyte viability after liposuction
Published: 2002 Feb
Attempting to identify a subpopulation of adipose cells found within the liposuction aspirate with the greatest viability, the authors of the study hoped to have a greater chance of an increase in survival after the transplantation. 20 individuals donated their liposuctions samples, which are centrifuged at 50 g at 2-minute intervals. The bottom or deepest layer of the samples had a constant first place in having the highest number of viable cells after the centrifugation.
Using only the bottom portion of the fat layer for transplantation can obtain a fat graft with a greater number of viable adipocytes. This means that it can potentially improve the survival of fat grafts and decrease the resorption of the fat grafts.
Summary: If using the bottom portion of the fat layer for transplantation, there is an increase in the survival rates of the fat grafts.
2001 Book – Structural Fat Grafting by Dr Sydney Coleman
detailing a technique of fat harvesting and grafting which resulted in a significant volume increase due to survival of the fat cells.
This technique was mainly used around the face. Facial Fat grafting was found to be of great benefit in the treatment of scars and radiation tissue damage.
2000 – Current concepts of fat graft survival: histology of aspirated adipose tissue and review of the literature
Published: 2000 Dec
There is still speculation on how long autologous fat grafts are in correcting, and their relation to adipocyte survival. Fat graft survival rates tend to differ with factors such as the harvesting method, means of reinjection, injection site, and evaluation methods. The aim of this analysis was to compare and demonstrate the histologic findings of aspirated adipose tissue with published studies.
Using literature and histology of transplanted fat 7 years situated or applied under the skin and trypan blue staining to determine the vitality of the defrosted adipocytes. Fat cells survive aspiration in either a suction machine or syringe at almost the same rate. The clinical longevity of correction after the fat transfer will be determined by the degree of augmentation that comes from the amount of fibrosis induced and the count of viable fat cells. The survival of aspirated fat cell grafts is dependent on the anatomic location, the mobility and vascularity of the recipient tissue, or the underlying causes and disease instead of the harvesting and reinjection approaches.
Summary: To determine the clinical longevity of correction after the autologous fat transfer, there is a need to measure the degree of augmentation that comes from the amount of fibrosis induced and several viable fat cells.