| Background: Autologous fat transplantation was transferring fat from an area where it was present in excess,such as the abdomen or thighs,and then injected into other parts of the body that were required,such as the face,breasts,scar,etc.At present,there is a lot of studies about autologous fat transplantation in mastectomy and breast reconstruction after breast cancer surgery.Due to recent application experience,no obvious possibility of concurrent breast cancer has been reported.Therefore,its application in non-secondary primary breast such as congenital breast dysplasia also small breast disease,breast atrophy after lactation,and other types of congenital breast malformations such as Poland syndrome has become more and more widespread.Objective: To investigate the clinical application and short-term effect of autologous fat transplantation in aesthetic breast augmentation and congenital breast malformation.Methods: Autologous fat transplantation were used for patients diagnosed with congenital breast hypoplasia or atrophic breast or congenital breast malformations such as Poland syndrome in our hospital from January 2017 toMay 2018.Including 13 cases of congenital breast hypoplasia,18 cases of breast atrophy,and 1 case of Poland syndrome.The age was 26-50,average 37 years old.The body mass index is 19.6 ~ 27.5(kg/m2)with an average of 21.6.All patients were intravenous anesthesia combined with local tumescent fluid infiltration.The liposuction site were the abdomen,waist,and thighs.A large cannula and a 20-ml syringe were used for liposuction manually,and filtration was purifing fat.Injection principle was three layers: subcutaneous layer,retroglandular layer,and retroandintra muscular layer.And multi-level multi-tunnel multi-point and fan-shaped injection.When prosthesis was removed autogenous fat transplantation was used in subcutaneous layer of the inner and upper parts of the breast and the surrounding area of the prosthesis.Some patients were treated with removing prosthesis then autologous fat transplantation.Postoperative follow-up was conducted,including pre-or postoperative photographs,breast ultrasound examination,complications and patient satisfaction.Results: A total of 32 cases were followed up.In 28 patients,autologous fat transplantation was used only,in 1 case autologous fat transplantation was performed after removing the prosthesis,and in 3 cases autologous fat transplantation was combined with prosthesis implantation(Poland syndrome was one of them).Only 1 session were needed to achieve the desired result.Follow-up was 6 to 22 months,an average of 12 months.29 patients were followed up by breast ultrasound.There were microcysts and calcification in breast ultrasonography mostly.The preoperative BI-RADS classification was mostly grade 1 or grade 2 and 1 case was grade 3.One preoperative BI-RADS grade 2 patient was examined as a BI-RADS grade 3 at 18 months postoperation,which reported the formation of larger fluid cysts in thoracicmuscle layer,and puncture biopsy was fat necrosis.Patient satisfaction evaluation were very satisfied with 26 cases,satisfaction with3 cases,general 2cases,unsatisfactory 1 case.Conclusion: Autologous fat transplantation seems to be the main method of aesthetic breast augmentation surgery,including congenital breast malformations such as Poland syndrome,Tuberous breast deformity,etc.Autologous fat transplantation can be applied alone or combined with prosthesis implantation,reflected by the high patient satisfaction and low incidence of clinical and radiological complications.Future research should focus on evaluating the technical and patient factors influencing the rate of fat survival as well as its oncological safety.Objectives: To determine the current worldwide status and evaluate the short-term efficacy and techniques and oncologic safety of autologus fat transplantation for aesthetic breast augmentation.Methods: A Cochrane systematic review of literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria was performed on November 2018 searching in Pub Med,EMBASE and the Cochrane Library databases to identify all relevant studies,regardless of language and type.A rigorous data extraction and standardisation process allowed pooling of clinical outcome data into a meta-analysis.This is the first meta-analysis on this subject,aimed to analyze patient and surgeon satisfaction and complications and volume retention.Results: A total of 74 articles published between 1987 and November 2018 consisting of 6011 patients were included and 57 studies consisting of 4885 unique patients were included in meta-analysis.Most of the studies had a low level of evidence with level 2b to 5,with only one was randomized controlled cohort but control group not up to our standard.In this meta-analysis the number of prospective cohort study was17,retrospective cohort study was 4.The number of case-control study was 4 and case series was 32.The publications were from20 countrys most in North America,Europe,and Asia.The indications were aesthetic augmentation(93.1%)and congenital malformation(6.9%).Two cases of cancer were reported among the 4885 patients included(0.04%),with a mean follow-up of 23 months,although the follow-up was insufficient for mediumand long-term cancer diagnoses.Meta-analysis revealed a very high overall patient and surgeon satisfaction rate of 93% and 87%,respectively,which was also confirmed by one study with high satisfaction VAS scores and four studies with Breast-Q scores.Overall,only 1.59 sessions were needed to achieve the desired result.Though evidence on the long-term volume survival is lacking,based on the current data it was calculated to be 50%~70% at one year.Only 8%of procedures resulted in clinical complications and 5% of patients required biopsy due to abnormal clinical or radiological findings.Conclusions: Autologous fat transplantation seems to be a major tool in aesthetic breast augmentation,reflected by the high patient and surgeon satisfaction and low incidence of clinical and radiological complications.Preoperative patient selection is essential but underreported.Future research should focus on evaluating the technical and patient factors influencing the rate of fat survival as well as its oncological safety. |
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