WHAT IS BREAST LIPOFILLING?

Lipofilling is an autologous tissue graft implemented by the infiltration of fat taken from the patient herself. The adipose (fat) tissue is aspirated where it is in excess by means of small cannulas connected to syringes and re-injected after a few minutes into the area to be treated.

Since no vascular connection to the donor site is preserved in the grafts, the transferred tissue can survive in the new site only if it is in direct contact with other well-vascularized tissues from which it will draw nourishment by imbibition or forming new vascular connections.

The lipofilling technique is therefore indicated for small corrections to be carried out by infiltrating small quantities of fat into well-vascularized tissues, and not for grafts of large quantities as in the latter cases there is a risk that the injected fat cells will not come into contact with the vascularized tissues and encounter necrosis and infections.

To overcome these problems, in 1998 Dr. Sidney Coleman devised his own personal technique, known as the “lipostructure”, which allows to obtain the same results as lipofilling overcoming its limits.

The first limit of traditional lipofilling is represented by the fact that a considerable amount of fat cells were damaged by the aspiration procedure and, once infiltrated, they were unable to take root and survive.

The lipostructure, on the other hand, provides that the adipose tissue is taken with very small syringes, aspirated at low pressure and then centrifuged to separate the viable fat cells from the damaged ones and their by-products. In this way, only intact cells are infiltrated, able to take root in their new location and survive.

The second limit, successfully overcome by Coleman’s technique, is the need to place all the infiltrated cells in direct contact with well-vascularized tissues.

To overcome this problem, the lipostructure requires that the infiltration of the fat takes place through multiple very small tunnels, in each of which a minimum quantity (less than 0.1 ml) of adipose tissue is deposited. The network of tunnels in which the fat infiltrates thus creates a “structure” arranged on various layers, from which this new procedure took its name.

The lipostructure therefore makes it possible to use body fat as a permanent filler for the correction of numerous defects, even if some limitations still remain due to both the absolute quantity of injectable fat and the particularities of the various anatomical sites to be treated.

A BIT OF HISTORY

The idea of ​​using fat from the same patient as a filler was used in the late 1800s by Neuber to treat facial defects.

In 1910 Lexer published an article on the use of fat in plastic surgery to increase the chin and zygomatic regions, and to fill wrinkles.

In 1950 Peer published a study describing the behavior of autologous adipose tissue grafted in the same patient for body profile correction. This technique, called “lipofilling”, spread rapidly but had some limitations due to the partial reabsorption of the injected fat and the poor duration of the correction, and faced some complications such as necrosis and infections.

In 1998 Coleman proposed a new technique, he called lipostructure (structured lipofilling or lipostructure) which allows to overcome the limits and avoid the complications of lipofilling through a special technique of preparation and infiltration of adipose tissue.

Among the various studies that have been carried out in the scientific world on lipofilling also at the Reconstructive Plastic Surgery department of the University of Florence directed by Prof. Mario Dini and the Department of Pathology and Experimental Oncology directed by Prof. Sergio Capaccioli has been carried out a study on a new method to reduce the damage caused to fat cells during purification and therefore make more vital tissue available to the surgeon.

The new technique developed by the Department of Reconstructive Plastic Surgery of the University of Florence directed by Prof. Mario Dini in collaboration with the Department of Pathology and Experimental Oncology directed by Prof. Sergio Capaccioli, allows to reduce the damage caused to cells adipose from the purification process and to have a greater quantity of vital tissue to infiltrate.

This technique consists of spreading the fat taken on a double-layer sterile gauze for five minutes, in order to separate the oily layer and the blood from the adipose tissue.

This filtration-absorption method results in less damage to adipocyte cells compared to the Coleman method, allowing for the transfer of more viable cells to the recipient site.

WHO IS THIS TREATMENT FOR?

The lipostructure technique is indicated for the rejuvenation of the face and hands, to modify the profile of some areas of the face (cheekbones, lips, nasogenic grooves, chin, jaw), to correct localized tissue atrophies (such as those resulting from injection intramuscular corticosterorides) or larger atrophies of traumatic or iatrogenic origin and to eliminate the adipose atrophy that appears in HIV positive patients undergoing therapy with protease inhibitor drugs.

Autologous fat infiltration is also used to increase or correct breast volume and to improve the consistency and aesthetics of breast tissue compromised by iatrogenic events (radiotherapy results, breast reconstruction with expanders or prostheses, etc.).

The main applications of the lipostructure on the breast are:

1) Small breast augmentation
The use of lipofilling and lipostructure to increase breast volume has long been debated due to the possible formation of calcified nodules deriving from liponecrosis, which can create ambiguous images and simulate or hide a cancerous lesion on mammography . A study by Brown, Sargent and Coehn has shown that all surgical procedures on the breast cause lumps and / or mammographic changes and that post-operative differentiation between benign calcifications and carcinoma can be done with a high safety rate.

2) Correction of deformities of the breast contour
At the end of breast reconstruction, both with autologous tissue and through the use of implants, areas with irregular contours can often remain, especially in the upper portion of the breast. These imperfections, being easily visible, can negatively influence the patient’s social life. Fat transplantation is the ideal choice to correct this type of blemish.

3) Reduction of capsular contracture
The lipostructure can also be used to correct capsular contracture. In a grade 3 or 4 capsular contracture, the lipostructure, associated with capsulotomy and the use of a smaller prosthesis, is an excellent alternative to a breast reconstruction with autologous tissue.

4) Treatment of tissue damage caused by radiotherapy
Another important indication of lipofilling and lipostructure is the treatment of damage induced by radiotherapy: the mesenchymal stem cells present in the adipose tissue allow revascularization and therefore the healing of damaged tissues. Several studies have in fact shown that the vascular-stromal fraction of adipose tissue contains a rich reserve of multipotent stem cells, with immunophenotype and pro-angiogenetic capacity comparable to stem cells derived from the bone marrow; they are responsible for the clinical improvements observed after the transfer of adipose tissue to the ischemic areas.

5) Correction of breast asymmetries

6) Correction of defects deriving from a restoration with prosthesis

7) Increase in thickness of the skin of the breast region functional to breast reconstruction with prosthesis

HOW IS THE PRE-OPERATIVE VISIT DONE?

Before proceeding with the lipofilling or lipostructure operation, it is necessary to undergo an accurate visit during which the surgeon will examine the location and extent of the corrections to be made, and the quality and characteristics of the tissues to be implanted in order to identify the surgical technique best suited to your case.

During the visit, the surgeon will evaluate your current and previous health status in order to exclude the presence of complications (such as, for example, high blood pressure or scarring or clotting problems) that could affect the final result of the intervention.

Finally, you will be given precise instructions on the diet to be followed before and after the intervention, and on the possibility of taking drugs, alcohol and cigarettes.

SURGICAL TECHNIQUES

Lipofilling and lipostructure are divided into three phases: the removal of adipose tissue, its purification by centrifugation or filtration-absorption and re-grafting in the area to be treated.

The removal of adipose tissue is performed under local anesthesia with sedation or under general anesthesia by means of micro needle cannulas connected to small syringes equipped with a tank for the collection of fat and its derivatives (stem cells, etc.).

The purification phase consists of centrifugal separation or filtration-absorption of the cellular elements (fat, stem cells, etc.) that the surgeon wishes to use.

The intervention ends with the re-engagement of the preparation in the receiving area by means of micro needle-cannulas connected to syringes.

The duration of the intervention, which can vary from 30 minutes to 2 hours, depends on the size of the area to be treated and on the technical times necessary for the purification of the adipose tissue.

WHAT TYPE OF ANESTHESIA IS PRACTICED?

The intervention of lipostructure is generally performed under general anesthesia without intubation (ie only with the aid of the laryngeal mask) and in an outpatient setting.

Lipofilling can also be performed under local anesthesia with sedation (this means that the patient will be awake, but relaxed and insensitive to pain).

Before the operation, the anesthesiologist will proceed to a careful pre-operative visit and prescribe a list of routine exams such as:

Electrocardiogram

CBC

PT, PTT, fibrinogen

Electrolytes

Blood sugar, azotemia, creatinemia

Serology (hepatitis B, C and HIV viruses)

WHAT IS THE POST-OPERATIVE COURSE OF BREAST LIPOFILLING INTERVENTION?

At the end of the intervention and in the days immediately following, swelling and bruising may appear around the donor area and the recipient area.

3-4 days after surgery, you can resume your work if not excessively tiring.

3 weeks after the surgery, you will gradually resume all normal activities including sports.

 

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BREAST LIPOFILLING & BRA BRAVA SYSTEM

WHAT IS THE BRAVA SYSTEM?

The Brava System is a bio-mechanical bra designed by an American plastic surgeon, Prof. Roger K. Khouri, who, by exerting negative pressure on the breasts, acts as an external breast expander. Wearing this special device before an operation allows you to prepare the tissues to receive the fat cells and wearing it in the post-operative period allows you to improve the engraftment of the grafted fat.

Thanks to the association of the Brava system with lipofilling, it is possible to graft more fat than a simple lipofilling intervention and therefore obtain a greater increase in volume and / or change in the shape of the breasts for patients who wish to undergo a total breast reconstruction post-mastectomy or an aesthetic breast augmentation without the use of prostheses, but exclusively with autologous tissue.

This highly technological system is composed of a bra in which a pair of semi-rigid cups are inserted which are placed over the breasts, equipped with a soft silicone edge that allows you to maintain negative pressure inside. Each shell is connected to a battery-powered suction pump which, thanks to a special microprocessor, allows to obtain a constant negative pressure of 15-25 mmHg.

HOW DOES THE BRAVA SYSTEM WORK?

The Brava system must be worn both before and after surgery. Depending on the protocol used, the time of use of the bra can vary from 10 hours a day up to 24 hours, for a maximum of about two months.

Thanks to the negative pressure that is created inside the cups, the breast tissues are subject to prolonged and three-dimensional tension: in response to mechanical stress, the space in which to inject fat increases, allowing to increase the transplantable quantity of fat cells . Furthermore, local edema is formed and vascularization increases, with consequent improvement of the engraftment of the adipocytes implanted through lipofilling.

HOW LONG SHOULD THE BRAVA BRA BE WEARED?

There are several protocols for using the Brava bra. The most used is that the device is worn for 3 weeks before surgery: the first 17 days must be worn for 10 hours a day, the last 3 days before breast lipofilling for 24 hours a day. After surgery, the Brava system should be worn 10 hours a day for 45 days.

DOES THE DEVICE NEED MAINTENANCE?

The Brava System has been designed so that the pump does not need maintenance. It is sufficient to wash the adhesive silicone edge of the cups with a mild soap after each use and rinse and dry thoroughly to minimize possible skin irritation.

IS THE BRAVA SYSTEM SAFE?

Absolutely yes. This system, conceived in 1999 by an American plastic surgeon, Prof. Roger K. Khouri, has six patents and was studied for seven years before being placed on the market. Subsequently it has been the subject of numerous clinical trials that have proven its safety and efficacy. It has also been approved by the American Health Supervisory Authority, FDA (Food and Drug Administration), and has been certified by ASAPS, the American plastic surgery company.

WHAT ARE “RIGOTTOMIES”?

It is an innovative surgical technique which, without incisions on the skin, through a needle, allows to stretch the tissues for a better distribution of the fat that will be injected through lipofilling .

WHO IS THE TREATMENT WITH THE BRAVA SYSTEM INDICATED IN ASSOCIATION WITH BREAST LIPOFILLING?

The use of the Brava system associated with breast lipofilling is indicated for women who want:

  • increase your breast volume without using breast implants
  • change the shape of your breast
  • undergo a post-mastectomy breast reconstruction without the use of silicone implants
  • restore shape and volume to a breast that has wasted with pregnancy and breastfeeding
  • correct a breast asymmetry, i.e. improve a difference in volume between the two breasts.

ARE THERE ANY AGE LIMITS TO SUBJECT TO THIS PROCEDURE?

There are no age limits to undergo this type of intervention, but it is preferable to wait for the complete development of the breast which generally takes place around the age of majority.

WHAT ARE THE RISKS AND COMPLICATIONS OF USING THE BRAVA SYSTEM AND BREAST LIPOFILLING INTERVENTION?

The Brava system is an absolutely safe device for women’s health. Most of the women who used this device, according to the instructions given by the plastic surgeon, did not complain of any particular pain or discomfort. During use, erythema or mild skin edema may appear, which are absolutely normal effects and which will disappear after about an hour after the end of use. In some cases, mild skin irritation may develop. In the very rare cases where the use of the Brava system causes a skin rash, it is necessary to stop the treatment and contact your plastic surgery specialist.

It is important to report any allergies to your surgeon as, although very rare, some women may be allergic to the materials that make up the device and therefore develop contact dermatitis. The appearance of itching, excessive swelling and bladders (blisters) is a sign indicating a possible allergy to the components of the system.

To minimize the risk of onset of skin irritation, it is advisable to apply a skin protection film (eg Cavilon Spray barrier film), which will come into contact with the silicone edge of the cups, and a non-oily moisturizing soothing lotion to end of each application to keep the skin well hydrated.

The lipofilling breast is a relatively simple procedure, safe, micro-invasive and easily repeatable in case of partial resorption of the grafted fat. Numerous studies, performed by the most authoritative Plastic Surgery centers worldwide and published in the most prestigious international journals of Plastic Surgery, have shown that breast lipofilling does not cause a diagnostic delay in breast cancer, as an expert radiologist can distinguish tumor-related calcifications from those due to lipofilling liponecrosis.

However, breast lipofilling remains a real surgery where the rare complications (bleeding, infection) can be easily resolved only if the intervention is performed by a specialist in plastic surgery within duly authorized structures. To reduce these risks it is very important to follow the advice and instructions provided by the surgeon before and after surgery.

WHAT OTHER INTERVENTIONS CAN BE CARRIED OUT TOGETHER WITH BREAST LIPOFILLING?

The lipofilling breast can be performed alone or in combination with other interventions of Aesthetic Plastic Surgery (blepharoplasty, rhinoplasty, facial lipofilling, etc.) Or reconstructive (reduction mammoplasty adjustment, breast lift adjustment, etc.).

HOW IS THE PREOPERATIVE VISIT DONE?

During the visit, the plastic surgeon carries out an accurate medical history to assess lifestyle and any pathologies and a clinical examination during which the areas of the breasts to be treated are identified, their extent and the amount of fatty tissue to be infiltrated.

The planning of the intervention is completed with the elaboration of a precise pre-operative design of the areas concerned.

Before surgery, the patient receives specific instructions on pre- and post-operative nutrition, on the intake of drugs, alcohol and cigarettes.

WHAT TYPE OF ANESTHESIA IS PRACTICED?

The lipofilling breast can be performed under local anesthesia with sedation (which means that you will be awake but relaxed and insensitive to pain), in outpatient care, or under general anesthesia with one or two nights of hospitalization.

ARE THE ENGRAVINGS VISIBLE?

The very small incisions, of a few millimeters, in the sampling sites are made in well-hidden areas, therefore the scars in clinical practice are substantially invisible. In the breasts there is absence of scarring results since lipofilling is carried out by micro-cannulas without any incision.

HOW LONG DOES THE INTERVENTION LAST?

The duration of a breast lipofilling operation is usually between sixty minutes and two hours, depending on the amount of fat to be implanted in the breasts. The surgery is not painful.

The surgical procedure ends with an elastic compression bandage to reduce any hematomas or edemas in the immediate post-operative period.

WHAT IS THE POST-OPERATIVE COURSE?

In the post-operative period, the use of a compression sheath is foreseen, to reduce any bruising or swelling, which is generally maintained for three weeks after the operation. Also in the post-operative period, there may be a slight soreness of the treated areas, which can however be controlled with commonly used painkillers.

The return to normal activities is gradual, over a few weeks.

The result, appreciable already after the first three weeks, will be definitively achieved after about six months from the intervention.

WHAT TYPE OF RESULT CAN BE OBTAINED WITH BREAST LIPOFILLING?

The result that can be obtained from the breast lipofilling  in association with the Brava system is generally very satisfactory, long-lasting and, after a partial resorption of the injected fat that varies from individual to individual, permanent. Just the partial reabsorption is the only limit of this intervention, which however can be repeated to improve the result  of breast lipofilling  after about six months from the first intervention.

HOW MUCH DOES BREAST LIPOFILLING COST?

The lipofilling breast can have very variable costs and prices. In fact, if it is a simple lipofilling to improve the contour of the prostheses and decrease the palpability of the breast implants, the price of breast lipofilling is around € 2,000 . If, however, it is a lipofilling aimed at a breast augmentation consisting of volume and shape, the price of breast lipofilling can be around € 6,000 . Finally, if it is a liposculpture aimed at the body remodeling of numerous anatomical areas, the price of the intervention is established more by liposculpture than by breast lipofilling. In this case the cost of the intervention is around€ 8,000 .

BREAST LIPOFILLING FAQ

Q. How do you apply for breast lipofilling surgery funding?
A. It is possible to request the payment in installments of the breast lipofilling intervention, asking your cosmetic surgeon what are the  methods of financing cosmetic surgery in cases where there is no immediate financial availability to pay for an intervention.

Q. Do I have to give my consent to the surgery?
A. Yes, before undergoing breast lipofilling, the patient must give their  informed consent to the surgery.

Q. Are there any indications for breast lipofilling?
A. There are no real contraindications to lipofilling, except for patients who have contraindications to surgery for other reasons. In the past, breast lipofilling was “investigated” as a possible technique that could induce breast cancer or hide and create suspicious calcifications in the breast. After years of studies, this possible event has been averted and it is possible to recognize small post-resorption calcifications of lipofilling from real pre-neoplastic or properly neoplastic calcifications. In fact, lipofilling is used precisely in post quadrantectomy or post mastectomy breast reconstruction. 

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