Bicompartmental Breast Lipostructuring - crf … · Bicompartmental Breast Lipostructuring M. L....

ORIGINAL ARTICLE

Bicompartmental Breast Lipostructuring

M. L. Zocchi Æ F. Zuliani

� Springer Science+Business Media, LLC 2007

Abstract The techniques of additive mastoplasty descri-

bed over the years require the use of alloplastic materials

(silicon), which often are poorly tolerated by the body and

need access paths that could leave visible, unaesthetic

residual scars. Furthermore, the controversy over silicone

gel-filled breast implants, which in the early 1990s

restricted their clinical use for primary cosmetic breast

augmentation, still raises concerns in some patients. The

authors therefore felt encouraged to search for alternatives

to breast implants and reconsider fat transfer. In fact, for

almost a century, autologous adipose tissue has been used

safely and with success in many other surgical fields for the

correction of volumetric soft tissue defects. Its natural, soft

consistency, the absence of rejection, and the versatility of

use in many surgical techniques have always made autol-

ogous adipose tissue an ideal filling material. In the past,

the authors used this technique, as originally described by

Fournier (intraparenchymal, en bloc injection), for 41

patients. However, disappointed by a very high rate of

complications and the almost complete reabsorption of the

grafted fat, they quit using the procedure. An extensive

literature review indicated that the complications observed

were related only to technical errors and to the anatomic

site of harvesting and implantation. The authors therefore

developed a new method incorporating recent contributions

in functional anatomy and fat transfer. Fat is harvested in a

rigorously closed system, minimally manipulated, and

reimplanted strictly in two planes only: into the retro-

glandular and prefascial space and into the superficial

subcutaneous plane of the upper pole of the breast

(bicompartmental grafting). Any intraparenchymal place-

ment is carefully avoided. Since 1998, 168 patients (300

breasts) have undergone this procedure. Grafted fat volume

has ranged from 160 to 685 ml (average, 325 ml) per

breast. Complications have been minimal and temporary.

All patients have been carefully monitored with preopera-

tive and serial postoperative mammograms and

ultrasonograms. This strict follow-up assessment allowed

the authors to clarify the controversial aspect of micro-

calcifications, the main point of criticism for this procedure

over the years. Microcalcifications can occur in response to

any trauma or surgery of the breast, but are very different

in appearance and location. Thus, they can be discrimi-

nated easily from those appearing in the context of a

neoplastic focus. Probably the most important point is that

the fat survival ranged from 40% to 70% at 1 year. The

volume is maintained because when the authors transplant

living fat tissue, they also transfer a consistent amount of

adult mesenchymal stem cells that spontaneously differ-

entiate into preadipocytes and then into adipocytes,

compensating for the partial loss of mature adipocytes

reabsorbed through time. This theory has been well dem-

onstrated via advanced research performed by the authors

and by many other prominent medical institutes worldwide.

The findings show that adipose tissue has the same

potential for growth of adult mesenchymal totipotential

stem cells of bone marrow and can eventually be differ-

entiated easily by the use of specific growing factors and

according to the needs and applications in other cellular

lines (osteogenic, chondrogenic, myogenic, epithelial). In

summary, the authors wish to highlight a formerly con-

troversial procedure that, thanks to recent technical and

clinical progress, has become a safe and viable alternative

to the use of alloplastic materials for breast augmentation

for all cases in which additive mastoplasty with implants is

M. L. Zocchi (&) � F. Zuliani

C. S. M. Institute for Aesthetic Plastic Surgery, 4, via Guarini,

Torino 10123, Italy

e-mail: [email protected]

123

Aesth Plast Surg

DOI 10.1007/s00266-007-9089-3

either unsuitable or unacceptable by the patient herself.

However this method cannot be considered yet as a com-

plete substitute for augmentation with implants because the

degree of augmentation and projection still is limited.

Keywords Adult stem cells � Alloplastic materials �Autologous adipose tissue � Breast augmentation �Breast lipostructuring � Fat transfer

Autologous adipose tissue has been used to correct soft

tissue defects for more than a century. Its soft and natural

texture, the absence of a line, and its versatility have

always made adipose tissue the ideal physiologic filling

material. The first surgeons using adipose tissue as a filling

material were Neuber [8], whose used it in 1893 to correct

facial defects, and Czerny [3], who used it in 1895 to treat

the sequelae of mastectomy. Since then, free grafts of

adipose tissue also have been used extensively in several

other fields of surgery including thoracic surgery (for filling

tubercular cavities), general surgery (to stop bleeding after

liver and kidney surgery), neurosurgery (for cranial defects

to obviate cerebral adherence), and orthopedic surgery (to

close bone defects).

In the 1950s, Peer [9] was the first plastic surgeon to

conduct extensive studies on the long-term survival of

autologous fatty tissue grafts. He reported that these grafts

lost more than 50% of their weight and volume after

1 year, and showed that most reabsorption occurred in the

larger fatty tissue particles and during the first 3 months

after the reimplantation.

In the 1960s, interest in autologous adipose tissue

grafting almost disappeared due to the ever-increasing use

of dermal adipose grafts, which proved to be more reliable

and long lasting. Furthermore, new artificial materials for

soft tissue augmentation (paraffin, fluid silicone, methac-

rylate, and others) became very popular despite the high

rate of complications.

Until the 1980s, fat transplantation had been performed

only as a soft tissue graft harvested en bloc with open

surgery, thus resulting in evident and ugly scars at both the

donor and receiving sites. Only in the mid-1980s did the

diffusion of syringe liposuction [4,5,12], which standard-

ized and popularized methods for harvesting fat in a simple

and safe manner, arouse renewed interest in free fat

transplantation. This has stimulated, since then, constant

evolution and technical improvement.

In 1986, Illouz [6] and Fournier [4,5] were the first to

define lipofilling as microlipoextraction and reinjection for

facial rejuvenation. Deeply involved in this field of

investigation, Zocchi [14-17] in 1989 described a method

for producing autologous collagen from fat manipulation

for face sculpting and rejuvenation. Then in France,

Fournier [4], extending his great experience and knowledge

Table 1 Limits and complications of intraparenchymal en bloc fat

grafts (old technique)

• Strong inflammatory reaction

• Steatonecrosis

• Infections

• Liponecrotic pseudocyst

• Intraparenchymal microcalcifications

• Unpredictable results due to the almost complete reabsorption

of the transplanted fat

Fig. 1 Instruments: (a)

Complete set with syringe,

syringe holders, cannulas, and

containers. (b) Special cannulas

2 mm in diameter, specially

coated. (c) Vibrating table used

for stratification of harvested

material

Aesth Plast Surg

123

Fig. 2 Functional anatomy of the

breast. ‘‘Fat constitutes more than

half of the weight of most breasts,

even small ones’’ [7]

Fig. 3 External skin expansion

with BRAVA�. (a) The

silicone-sealed cups are

positioned over the breast. (b)

The miniaturized pump is

connected. (c) The containing

bra supports the cups and pump

Fig. 4 Donor-site selection with respect to the ‘‘methameric theory,’’ which postulates that fat reimplanted on the same side (left on left/right on

right) from which it was harvested has a greater chance of survival

Aesth Plast Surg

123

Fig. 5 Surgical planning. (a)

Preoperative drawing

delimitating the reimplantation

sites on both the retroglandular

and superficial planes. (b)

Hypertrophy of the upper poles.

(c) Postimplantation touch-up.

(d) Severe hypotrophy. (e)

Asymmetry

Fig. 6 Fat harvesting

Aesth Plast Surg

123

of fat transfer to the face and other body areas, described a

personal technique of ‘‘en bloc intraparenchymal’’ fat

grafting into the breast.

From January 1991 to December 1993, we used the

Fournier technique for 41 patients, then discontinued its

use because we were disappointed with the very high rate

of complications (Table 1), and above all, with the lack of

predictability and durability due to the almost complete

ultimate reabsorption of the grafted fat. Our experience

with this old technique reflected the controversial judgment

of the international scientific community on it. Moreover,

the literature review also indicated that all the complica-

tions observed were strictly related to technical errors

during the harvesting and preparation of the fat, and most

of all, to the technique and the anatomic site of reimplan-

tation [13].

Furthermore, the well-known controversy over silicone

gel-filled breast implants (resulting in law-enforced sus-

pension of their clinical use for primary cosmetic

augmentation mammoplasty in the early 1990s, first in the

United States and then in many other countries), the non-

acceptance of having artificial alloplastic materials in the

body, and the residual scars still raise major concerns with

some patients. The result is a specific contraindication for

traditional augmentation mammoplasty.

Considering the aforementioned problems and seeking

to find safe and reliable alternatives to implants, we

developed a new technique of fat transplantation for breast

augmentation called ‘‘bicompartmental breast lipostruc-

turing’’ [20,21]. This name takes its origin from the fact

Fig. 7 Fat preparation. (a) Gentle

washing with saline solution. (b)

Stratification by vibration. (c)

Stratification by decantation. (d)

Conservation in cold saline

Fig. 8 Breast setup. (a) Antiseptic packing. (b) Nipple shield

Aesth Plast Surg

123

that fat tissue is rigorously reimplanted in two specific

anatomic areas of the breast only.

Materials and Methods

Clinical Outcome

From 1998 to 2007, 181 women with a mean age of

33 years were treated with the aforementioned technique.

All the patients underwent major or mild body con-

touring at the same time, and 60% were treated for

augmentation and volume asymmetry. Of the latter

patients, 12% had a combined reductive mastoplasty for

the contralateral breast using the ultrasound technique.

Symmetric volume augmentation of both breasts was

performed for 36% of patients, whereas 11% underwent

correction of sequelae originating from previous breast

surgery as well as augmentation (6%), reduction (2%), or

mastopexy (3%).

Instruments

A specially designed Teflon-coated cannula 2 mm in

diameter with a single lateral hole and connected to a

disposable 60-ml syringe with a tapered tip is used to

harvest the adipose tissue. A steel stopper device helps to

maintain the vacuum in the syringe during the aspiration

phase.

Two specially designed cannulas (Fig. 1a and b) with

the same features as the cannula used for harvesting are

used to perform reimplantation of the fat: a straight flexible

27-cm-long cannula for the deeper retroglandular plane and

a stiffer 25-cm-long curved one for reinjection of the fat in

the subcutaneous plane and for redefining both the breast

crease and the inframammary fold.

Fat is not centrifugated, so no centrifuge is necessary. A

vibrating table (Fig. 1c) and specially designed syringe

holders are used to speed up the cleaning phase and the

stratification process. The fat ready to be reimplanted is

then preserved in metal cylindrical containers filled with

cold saline.

Technique

We devised a new surgical technique that incorporates the

most important recent contributions in functional anatomy

of the breast [7] (Fig. 2) and fat transfer [1,2,14–17]. We

aimed to find logical solutions to all the shortcomings

observed in the earlier version of breast grafting and to

obtain more predictable and stable results. The new tech-

nique involves eight technical steps:

Fig. 9 Fat transplantation. Fat

tissue is inserted in two planes:

retroglandular (a,b) and

superficial (c,d)

Aesth Plast Surg

123

1. External breast skin expansion (using BRAVA,

BRAVA, LLC, Miami, FL)

2. Surgical planning (breast and donor areas)

3. Body contouring setup

4. Fat harvesting

5. Fat preparation

6. Breast setup

7. Fat transplantation

8. Manual reshaping.

Fig. 10 Manual reshaping. Fat

tissue is carefully molded and

reshaped to obtain a smooth and

regular surface

Aesth Plast Surg

123

External Breast Skin Expansion

The patient is asked to wear a special breast expansion device

(BRAVA) 30 days before surgery for 12 h a day. This

device, invented and distributed worldwide by the American

plastic surgeon Roger Khouri, stimulates vasculogenesis and

lymphatic activity, opening the spaces to create the ideal

situation for fat reimplantation. Unfortunately, this step

requires high patient compliance and cooperation. Because

of the discomfort in wearing the device, it is not always

accepted. Whenever patients have cooperative in wearing

BRAVA, the reimplantation phase has been facilitated and

the rate of fat survival definitively higher (Fig. 3).

Surgical Planning

In the bicompartmental breast lipostructuring procedure,

careful and precise planning of both donor (body) and

receiving (breast) areas must be performed.

Donor site (body) The donor sites selected the most often

are the trochanteric and gluteal regions, with respect, if

possible, to the homolateral receiving hemisoma (right to

right/left to left). This marking, done with the patient in the

standing position, must be adapted to the different clinical

situations (Fig. 4).

Table 2 Rating of the aesthetic results

Results Patients

(n)

Evaluation

(%)

Surgeon

(n)

Evaluation

(%)

Insufficient 5 3 10 6

Fair 10 6 25 12

Good 128 72 123 69

Excellent 38 23 23 13

Table 3 Complications of bicompartmental lipostructuring

N %

Edema 181 100

Bruising 143 78

Dysesthesia 14 5.8

Liponecrosis 2 1.2

Microcyst 3 1.8

Microcalcifications 7 3.9

Table 4 Radiologic follow-up evaluation

• Sonography, preoperative, 6 months, 1 year

• Mammography preoperative, 1 year (Fig. 11)

• Magnetic resonance imaging (MRI) on demand (Fig. 11)

Fig. 11 Mammography. (a)

Before bicompartmental breast

lipostructuring. (b) Enlarged

volume of the adipose prefascial

plane (radiotrasparency) after

1 year. (c) Magnetic resonance

imaging (MRI) showing

enlarged breast with normal

healthy fat before surgery and

(d) 1 year after surgery (R.

Khouri)

Aesth Plast Surg

123

Receiving site (breast) The most empty areas of the

superior quadrants and any volume asymmetry or dis-

crepancy in height and position of the submammary fold

are carefully marked preoperatively on the breast while the

patient is in the standing position (Fig. 5).

Body-Contouring Setup

The bicompartmental technique often is used as a com-

plement to extensive circumferential body-contouring

surgery (ultrasonic lipoplasty). The patient is first disin-

fected in the standing position with a nonalcoholic solution

to reduce the chance that the preoperative marking will be

wiped off. General anesthesia then is induced on a surgical

sterile bed. After the patient has been turned in the prone

position onto another adjacent sterile bed, the areas to be

treated are infiltrated with room-temperature saline using

2 mg of adrenaline per liter, usually starting from the left

side of the body.

Fat Harvesting

Fat is harvested in a rigorous closed system using dispos-

able tapered-tip 60-ml syringes and a 2-mm single-hole

Teflon-coated special cannula (Fig. 6). The fat tissue usu-

ally is harvested only in the posterior areas of the body,

with care to avoid, whenever possible, the inner face of the

thighs and the abdominal area. During the harvesting

phase, the surgeon must constantly remember to avoid

creating asymmetries or irregularities at the donor sites.

The relevant quantity of fat necessary for a bilateral breast

lipostructuring is based on extensive knowledge

concerning the principles of traditional body contouring

and a respect for all its technical steps (planning, infiltra-

tion, deep plane, superficial plane).

Fat Preparation

After the harvesting phase, the fat tissue is prepared with

minimal manipulation. A gentle washing with saline solution

in the same syringe used for harvesting is done to remove all

undesirable components (blood, saline, oil) (Fig. 7a).

During the preparation phase, the syringes full of har-

vested fat tissue are maintained in an upside-down position

with specially designed syringe holders. Then the syringes

are placed for 30 s on a sterile vibrating device to speed up

the stratification process, leading to separation of the har-

vested material into two main layers: fat tissue and fluid

(Fig. 7b and c).

Centrifugation is not necessary and not recommended in

this procedure. Handling such a large quantity of fat for

reimplantation (up to 2,000 ml) would dramatically

increase the duration of this step. Furthermore, the centri-

fugation phase of 5 min at 3,000 rpm, as described by

Coleman [1–3], has been demonstrated to increase the

apoptotic death rate for adult mature adipocites. [10,14–

17]. After preparation, the harvested adipose tissue is

preserved in the same syringes used for harvesting plunged

in cold saline (Fig. 7d).

Breast Setup

Once the harvesting and the body-contouring phases are

completed in the posterior areas, the patient is turned over

Fig. 12 (a–c) Preoperative

views of a 30-year-old woman

with a severe breast hypotrophy.

(d–f) Postoperative views

2 years after a bicompartmental

breast lipostructuring procedure

that reimplanted 290 ml of

adipose tissue in each breast

Aesth Plast Surg

123

on the surgical table and placed in the supine position for

completion of the anterior body contouring and for the

breast lipostructuring. During all this time and until the

moment of reimplantation at the very end of the surgery, an

iodine solution (Betadine) packing is applied to the breast

area. The nipples are protected by adhesive nipple shields

to avoid any contamination of the grafted area by acci-

dental spreading of glandular secretions, often at the origin

of inflammatory and infectious reactions (Fig. 8).

Fat Transplantation

Fat is reimplanted through a small incision made with a no.

11 blade in the medial portion of the inframammary fold.

Two specially designed self-lubricated 2-mm cannulas are

used for this step: a straight flexible 27-cm-long cannula

for the deeper retroglandular plane and a stiffer 25-cm-long

curved one for reinjection of the fat in the subcutaneous

plane and for redefining the breast crease and the infra-

mammary fold. The fat transplantation technique is

performed only into the retroglandular/prefascial plane and

into the superficial subcutaneous tissue of the upper pole of

the breast (bicompartmental grafting) in hundreds of ret-

rograde paths, with care to avoid any intraparenchymal

placement.

After insertion, the cannula should stay parallel to the

chest-wall and then proceed upward through the retro-

glandular space, always in touch with the pectoralis

aponeurosis until it reaches the superior preoperative marks

(Fig. 9a), As its tip goes beyond the gland, keeping on the

same level in this area, it actually ends up being in the

subcutaneous plane. The first fat-filled syringe is connected

(Fig. 9b). The assistant’s hand should be used as a barrier

to prevent any accidental spreading of fat in undesired

areas.



with moderate upper pole breast

hypotrophy. (d–f) Postoperative

views 1 year after a

bicompartmental breast

lipostructuring procedure that

reimplanted 310 ml of adipose

tissue in each breast

Aesth Plast Surg

123

After completion of fat insertion behind the gland, the

adipose tissue is injected along the inframammary crease

and the breast medial border. At this time, a curved

cannula should be used to allow grafting along the

rounded outline. The curved cannula is kept in a strictly

subcutaneous plane and must be rotated by 90�. At

the end, its tip will be oriented upward, with its hole

facing the dermis, to prevent fat from being injected too

deeply.

The adipose tissue is injected as the cannula is with-

drawn. The amounts should be limited to the bare

minimum needed to fill up the tunnels left by the cannula

(i.e., 2–3 ml of fat for each tunnel). Any excess could

determine surface irregularities. At the end of the proce-

dure, the incision must be meticulously and tightly sutured

with a reabsorbable thread (Fig. 9a–d).

Manual Reshaping

Next, implanted fat tissue is carefully distributed to obtain

a very regular and smooth surface. The aim of this

important and delicate phase is to reproduce the shape of an

anatomic implant, especially in the upper pole, where it is

important to create a natural and physiologic fullness,

avoiding excessive roundness or unaesthetic stepping.

Once fat grafting has been completed, the adipose tissue

is redistributed and molded so as to flatten out any irreg-

ularity along the borders. About 10 ml of Vaseline oil are

used as a lubricant. This maneuver, performed using both

fingertips and the radial edge of the hand, requires much

pressure, but does not damage the adipocytes because

compression is exerted on the tough bony surface rather

than on the grafted fat itself.



with moderate upper pole breast

hypotrophy. (d–f) Postoperative

views 1 year after a





Aesth Plast Surg

123

Peripheral squeezing maneuvers are performed along

the marked curved mammary outline while the whole

breast surface is carefully checked for detection of any

superficial unevenness. It should be noted that all this

will not displace the fat in undesired areas because the

latter has been inserted following crisscross vectors.

Consequently, septa of connective tissue act as a barrier,

preventing any adipose tissue from sliding beyond the

traced breast border. This desirable ‘‘fence’’ effect will

last during the whole healing process. At the end of the

treatment, an elastic roll is fixed to maintain the space

between the breasts, and a sports bra with shaped cups

and no wire is used to support the breast for 4 weeks

(Fig. 10a–g).



who underwent surgery 2 years

previously for a round-block

mastopexis presenting with a

moderate loss of volume in the

upper poles of the breast,

insufficient projection of nipple-

areolar complex, and diffused

skin irregularities. (d–h)

Postoperative views 6 months

after a bicompartmental breast




Aesth Plast Surg

123

Results

Since 1998, a total of 181 patients have undergone the

aforementioned procedure (145 bilateral and 36 monolat-

eral), for a total of 326 breasts. Grafted fat volume has

ranged from 160 to 745 ml (average, 375 ml) per breast.

Volume persistence at 1 year was up to 70% (average,

55%). It is noteworthy that transplanted fat reabsorption

was significantly reduced, thanks to the improved har-

vesting and grafting technique and, above all, to the choice

of reimplantation site.

A few patients who had undergone simultaneous

extensive body contouring (ultrasonic megalipoplasty) and

had lost significant weight after the surgery sometimes

Fig. 16 (a–d) Preoperative


showing a severe loss of volume

in the upper poles of the breasts,

poor definition of the mammary

crease, and asymmetries 6 years

after reductive mastoplasty. (e–

h) Postoperative views

6 months after a



implanted 500 ml of adipose

tissue in the left side and 400 ml

in the right side

Aesth Plast Surg

123

complained about an insufficient volume increase. More

often, patient satisfaction was higher than surgeon satis-

faction (Table 2).

The most common side effects during the first 2 weeks

after surgery were localized edema and slight bruising.

Overall, complications (Table 3) were minimal and tem-

porary. Three cases of pseudocysts resolved spontaneously

over a period of 6 months. In a series of 171 patients

treated with the described procedure during an 8-year

period, to date, only 6 cases of microcalcifications have

been monitored (rate of 3.9%): one bilateral in the upper

pole and the others unilateral in the prefascial retroglan-

dular plane.

All the patients were carefully monitored with preop-

erative and serial postoperative mammograms and

ultrasonograms (Fig. 11). This close follow-up evaluation

allowed us to clarify the most controversial aspect of

microcalcifications, which has been the main point of

criticism for this procedure over the years.

Microcalcifications cannot be completely prevented, and

they can occur in response to any trauma or surgery to the

breast. However, they are very different in appearance and

location and generally can be distinguished easily from

those appearing in the context of a neoplastic focus. For

instance, it also is very important to clarify that all the other

breast surgeries lead to the formation of microcalcifica-

tions, with the highest rate (\15%, Sadove [11]) related to

reduction mammoplasty.

A correct radiologic follow-up assessment (Table 4) and

a meticulous record of the surgical procedure usually have

been sufficient to clear any diagnostic concern. Good

communication with the radiologists is mandatory. In those

rare instances of persistent doubt, we could be confronted

by a false-positive, and although this generates distress in



with too visible breast implants,

insufficient soft tissue coverage,

and poor crease definition. (d–f)Postoperative views 2 years

after a bicompartmental breast




Aesth Plast Surg

123

the patient, it can be easily clarified with a simple tridi-

mensional (stereo-tassic) biopsy.

Clinical Experience

Figures 12, 13, 14, 15, 16, 17, 18

Conclusions

Current techniques for augmentation mammoplasty involve

the use of alloplastic materials and an open approach. The

former may not be well tolerated and often can be the

origin of undesirable effects such as capsule contracture.

The latter implies residual scars, which can sometimes be

less than satisfactory from an aesthetic point of view.

Constant research in this field, progressive improvement

in design and biocompatibility of breast implants, and the

evolution of surgical techniques have led to shorter and

better-hidden scars, reducing, however, only partially all

the aforementioned shortcomings and problems. Further-

more, the well-known controversy over silicone gel-filled

breast implants, which in the early 1990s resulted in a

suspension of primary cosmetic augmentation mammo-

plasty from clinical use in the United States, has not been

completely overcome, and still raises concerns with some

patients.

A thorough review of the literature suggests that all the

common complications observed in the past can be attributed

to methodologic errors, mainly related to the technique for

harvesting and to the anatomic site of reimplantation. There

is no evidence or proof of specific problems related to the

intrinsic features of the fat tissue itself as augmentation

material. In fact, the use of fat for correction of volumetric

soft tissue defects is almost 100 years old, first accomplished

with an open surgical approach and then with less invasive

techniques. Its softness, good tolerance by the body, and

versatility in many clinical situations make fat the most

desirable autologous filler material.

Therefore, we wish to call the attention of the interna-

tional scientific community to a controversial and, in the

past, abandoned procedure. All recent technical and clini-

cal advances have minimized complications and

dramatically increased transferred fat survival and volume

persistence. If well done, bicompartmental breast lipo-

structuring can be the most viable and safe alternative to

the use of prosthetic material for breast augmentation in

selected cases (Table 5). It offers to both patients and

surgeon many benefits and advantages (Table 6).

A very common observation is the fact that the majority

of the patients treated with bicompartmental breast

Fig. 18 A very interesting case of a 20-year-old woman. At the age

of 15 years, she underwent an augmentation mammoplasty of the left

breast only to correct a severe hypoplastic left breast and the related

asymmetry. At first observation, the patient showed a severe

asymmetry with excessive volume of the left breast. The patient also

complained of stiffness, irregularities of profile, and contraction of the

left breast (a). The implant was removed (b–d), and after 6 months,

extensive lipoplasty of the body and bi-compartmental breast

lipostructuring was performed to reimplant 435 ml of adipose tissue

in the left breast only. View 1 year after surgery (e,f)

Aesth Plast Surg

123

lipostructuring present with consistently improved skin

quality in terms of both elasticity and texture. Skin stretch

marks, especially in the lateral area and around the nipple-

areola complex, very often are less evident. This evidence

confirms that the transfer of fat tissue acts not only as a

volume replacement, but also as a tissue regenerator. This

observation is supported by the most recent studies on adult

stem cells contained in adipose tissue, conducted by us and

others groups worldwide [2,18,19].

The most advanced research has been able to demon-

strate that adipose tissue presents the same high potential of

growth as mesenchymal totipotential bone marrow stem

cells. However, the harvesting of bone marrow is definitely

more traumatic and limitative. In contrast, adipose tissue

can represent an inexhaustible source of easy and imme-

diately available mesenchymal cells for clinical application

in all areas of medicine that care for the regeneration of

autologous tissue. In fact with a modest quantity of adipose

tissue, we have demonstrated that it is possible to obtain,

through rigorous isolation and culture techniques, a large

quantity of totipotential stem cells that can eventually be

differentiated easily according to various needs (adipose,

cartilaginous, bone, endothelial, muscular, hepatic tissues

and pancreatic cells).

For all the aforementioned benefits, if well performed

following all the technical steps, bicompartmental breast

lipostructuring should be considered a safe and viable

alternative to traditional augmentation mammoplasty for

all cases in which additive mastoplasty with implants is

either unsuitable for the patient or unacceptable to her.

However, it is not our intention to propose this method as a

complete substitute for breast augmentation with alloplas-

tic implants. The achievable volume and projection of the

mammary cone still are limited, even if augmentation is

mainly localized at the upper pole, the most critical area of

early aging and volume loss.

References

1. Coleman SR (1997) Facial recontouring with lipostructure. Clin

Plast Surg 24:347–367

2. Coleman SR (2006) Structural fat grafting: More than a perma-

nent filler. Plast Reconstr Surg 118(3 Suppl):108S–120S

3. Czerny V (1895) Plastischer Ersatz der Brustdruse durch ein

Liporna. Chir Kongr Verhandl 2:216

4. Fournier P (1986) La liposculture. Arnette, Paris

5. Fournier P (1985) Microlipoextraction et microlipoinjection. Rev

Chir Esthet Fr X:19–23

6. Illouz YG (1986) The fat cell graft: A new technique to fill

depressions. Plast Reconstr Surg 78:122

7. Lejour M (1997) Evaluation of fat in breast tissue removed by

vertical mammaplasty. Plast Reconstr Surg 99:386–393

8. Neuber F (1893) Fettransplantation. Chir Kongr Verhandl Dsch

Geselsch Chir 22:66

9. Peer LA (1950) Loss of weight and volume in human fat grafts

with postulation of ‘‘cell survival theory. Plast Reconstr Surg

5:217

10. Rigotti G, Marchi A, Galie M et al (2007) Clinical treatment of

radiotherapy tissue damage by lipoaspirate transplant: A healing

processpediated by adipose-derived adult stem cells. Plast Rec-

onstr Surg 119:1409–1422

11. Sadove R (2004) Reduction of the breast with liposuction only.

First European symposium. Aesthetic surgery of the breast, Milan

9-11 December 2004

12. Toledo LS, Mauad R (2006) Fat injection: A 20-year revision.

Clin Plast Surg 33:47–53

13. Valdatta L, Thione A, Buoro M, Tuinder S (2001) A case of life-

threatening sepsis after breast augmentation by fat injection.

Aesth Plast Surg 25:347–349

14. Zocchi ML (1988) Production de collagene autologue par trait-

ement du tissu adipeux avec ultrasons. Congres de la Societe

Francaise de Chirurgie Esthetique, Paris, May

15. Zocchi ML (1989) Les implant mixte de collagene autologue

dans le remodelage facial. Rev Chir Esthet Fr 14:37–48

16. Zocchi ML (1989) Remodelage facial complet par implants de

collagene autologue. Revue Francaise de Chirurgie Esthetique

14:63

17. Zocchi ML (1990) Methode de production de collagene auto-

logue par traitement du tissue graisseux. J Med Esthet Chir

Dermatol 17:60

18. Zocchi ML (2006) Stem cells from fat. Abstract book of 10th

Annual Meeting of the Turkish Society of Aesthetic Plastic

Surgery, June

19. Zocchi ML (2006) New perspectives in plastic surgery: Adipose-

derived stem cells (ADSC.).Abstract Book of the I.S.A.P.S.

World Congress of Rio de Janeiro, August

20. Zocchi ML (2007) Bicompartmental breast lipostructuring. E-

Poster IPRAS World Congress, Berlin, July

21. Zocchi ML (2007) Bicompartmental breast lipostructuring. In:

Botti G (ed) Aesthetic mammoplasties. SEE, Florence, October

Table 5 Indications for bicompartmental breast lipostructuring

• Contraindications or refusal of implants

• Moderate volume expectation

• Moderate mammary ptosis

• Volume loss in mammary upper pole

• Asymmetries

• Implant irregularities (wrinkles, steps, rippling)

• As a complement of a body contouring

Table 6 Benefits of bicompartmental breast lipostructuring

• Minimally invasive procedure

• Unnoticeable scar

• Realizable in local anesthesia

• Short recovery

• Ideal complement to a body contouring procedure

• Push-up effect

• Natural look

• Natural touch

• Improved quality of skin texture

Aesth Plast Surg

123

Date post:	20-Sep-2018
Category:	Documents
Upload:	vanmien
View:	213 times
Download:	0 times

Bicompartmental Breast Lipostructuring - crf … · Bicompartmental Breast Lipostructuring M. L....

Documents