Objectives: Breast augmentation with fat has become well established method with expanded indications. Traditionally, fat grafting has different processing methods. We retrospectively evaluated the indications and compared aesthetic breast augmentation by four different processing methods of fat.

Introduction: Since 2008, Oslo Plastikkirurgi Clinic has performed 151 bilateral breast enlargements (301 breasts) using fat grafting to treat hypoplasia mammae, asymmetry, simultaneous with mastopexy or with other procedures like abdominoplasty and tuberous breast. Recently the indication was extended to be complementary to implant: add volume and shape (Hybrid or Composite) and to replace implants with fat (Conversion).Criteria for treatment include an alternative to implants; excessive fat; a realistic expectation of volume; no history of breast cancer; and radiographic evaluation.

Materials / method: Fat was machine-centrifuged in 1 group for 3 min. with 3000 rounds per minutes in 27 patients, and manually centrifuged for 3 minutes in another group of 45 patients. In a third group of 16 patients the fat was decanted for 10 minutes and in a fourth group a vibration technique (Microair) was used when harvesting the fat and to the recipient site in 61 patients. A single patient was motivated to use BRAVA has also been operated twice. Fat was harvested from the abdomen, thigh, buttocks, or knee and grafted in intersecting and parallel canals through small incisions. Harvesting cannula was 4 mm

Results: Average grafted fat in the first séance was 232 mL (left side) and 229 mL (right side) in the machine group and 227 and 235 mL in the manual group, respectively. In the second séance the amount was 110 and 111 mL, compared with 117 and 126 mL. In the decanting group (3) and decanting with vibrating technique group (4) the average grafted fat in first séance was 298 mL (left side) and 282 mL (right side) and 397 and 360 mL respectively. In the second séance the amount was 244 and 234 mL, compared with 184 and 182 mL. The satisfaction rate was higher in the third and fourth groups over 90%.

Conclusion: Patients obtained a natural feeling and better fullness. The favorable results with manual centrifugation and decanting might be related to the lesser gravitational force, resulting in better survival for fat. However, not all patients obtained the desired volume. Follow up and satisfaction rate which were evaluated by photographical, clinical and patient assessment have some limitations. The effect of factors such as local anesthesia, type of cannula, preoperative expansion, and amount of injected fat is still unclear. We recommend decanting with vibration method.

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Objectives: Total breast reconstruction only with fat transfer

Introduction: Breast reconstruction, when it’s possible, is very often asked by women.
They are now many problems with implants (PIP troubles with bad silicon gel, lymphoma with textured implants, pain with radiotherapy and implant ……). There is also a lot of patients afraid by flap reconstruction (very long surgery, flap necrosis, pain on donor site ….). Fat injection becomes more and more often a good solution for this woman.

Materials / method: Many patients prefered 3 or 4 fat transfer, in one-day surgery, without an implant, without scar and pain on the donor site. We for 6 years, we performed 1000 fat transfer for breast reconstruction. More than 100 women had total breast reconstruction by fat, 20 % was immediate breast reconstruction, 30 % for implant replacement and 50 % for delayed breast reconstruction.

Results: We have good results in many cases, with, on average, 3 to 4 surgery (every 4 months, 280 ccs of fat injected at each operation, 950 ccs on average for total reconstruction, 50 % had radiotherapy before the first injection ). That kind of surgery has a low rate of complication, very good results and it’s an easy technic to teach.

Conclusion: We think that we will get more and more indication for that technic and we must propose it, when it’s possible, to all women. More and more patients with painful implant breast reconstruction ask for replacement of the implant by fat, but they refused very often Flap reconstruction with their high complication rate.
Breast reconstruction with only fat transfer will become more and more the solution for women who refused implant and flap.

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