01. Breast enhancement by means of a suspension of adipose and stromal cells L’Adipofilling®
KEYWORDS: liposuction, Adipofilling®, breast enhancement, breast asymmetry, lipofilling, Lipostructure™
Adipofilling® transforms the lobular fat extracted during liposuction into a suspension of adipose and stromal cells which can be injected by means of a syringe. Adipofilling® is used to enhance breast volume and correct breast asymmetry, and does not cause calcifications or any other side effects. Surgery is carried out under local anaesthesia. The adipose tissue is preferably removed during liposuction of the abdomen, hips or trochanter.
Adipofilling® helps to improve two areas of the body; excess fat in one area of the body is used to enhance breast volume and to correct breast asymmetry.
Anaesthesia is carried out by using a modified Klein solution which is composed of a lactate Ringer solution with 20ml of mepivacaine 2% and half a milligram of epinephrine.
Liposuction is carried out by means of a syringe and a 4 or 5 mm cannula. The lobular fat that has been removed is washed in an erlenmeyer flask to eliminate the blood, anaesthetic and epinephrine. After washing has been completed, the fat lobules are broken up by using an Adipopimer® (Korpo srl). The cellular suspension is then ready to be injected through a fine cannula to create a new infra-mammary sulcus.
Single cells are incorporated into the breast stroma and are more easily nourished) than the lobular fat used in traditional lipofilling.
A fine cannula is used to inject the Adipofilling® suspension into the back of the breast.
An anaesthetic is injected into the introductory points. An 18 G needle is used to inject the cellular suspension. The breast is divided into segments and a predetermined amount of the filler is injected into the subcutaneous tissue of each segment by means of a syringe. The suspension of adipose and stromal cells spreads throughout the breast tissue in the same way as a physiological solution would.
Light massaging of the area helps to spread the filler. No calcification or hardening remains after surgery.
A week after surgery, the asymmetry has been corrected and the volume of the breast has been clearly enhanced. A month later, if everything has proceeded well, the implanted cells start to increase in size. After a year, the procedure can be repeated in order to enhance the situation further.
Adipofilling, before and after two years
Before and after Adipofilling®
Capurro S. (2008): Breast enhancement by means of a suspension of adipose and stromal cells: Adipofilling®. CRPUB Medical Video Journal. Adipofilling section. http://www.crpub.org
In Adipofilling®, cell survival is better than in other methods of transferring adipose tissue. Is this due to the fact that the filler is a suspension of cells?
Yes, individual cells survive better than lobules and are much more easily nourished. Fragmenting the adipose lobules causes far less damage to the cells than centrifugation at 3000 rpm, which is sheer madness.
First of all, it is not clear what is meant by 3000 rpm. We should use the term “atmospheres”. In any case, we can suppose that 3000 rpm corresponds to about 1500 atm. This treatment causes a portion of the adipose cells to burst (a lot of oil is seen in the supernatant). Moreover, on electronic microscopy, the apparently whole adipocytes display numerous micro-vacuoles, which is by no means a good sign. By contrast, after mechanical fragmentation, a minimal amount of oily supernatant is seen and the size of the adipocytes (100,000 nm) safeguards them against damage. Anyone who is familiar with granulometry is well aware of this.
Is Adipofilling® of the breast an ambulatory procedure? How long does it take?
Yes. Adipofilling® is an ambulatory procedure. It only takes a few seconds to transform the lobular fat into a cellular suspension with the Adipopimer®; washing the lipoaspirate takes longer.
Why does the lipoaspirate need to be washed?
Washing removes any anaesthetic, epinephrine and blood that may be present. To reduce the washing time, an anaesthetic solution of 1 mg of epinephrine in 500 ml of lactate Ringer solution can be prepared; the operator then waits 10 minutes after infiltration. This limits the amount of blood in the lipoaspirate, thereby reducing the washing time; indeed, the presence of blood in the lipoaspirate necessitates more prolonged washing.
To make up the anaesthetic solution is it necessary to use mepivacaine?
Studies conducted by diabetologists have shown that lidocaine prevents glucose from entering the adipose cells. However, after thorough washing, we have not observed substantial clinical differences between mepivacaine and lidocaine, however we use mepivacaine.
How much can breast volume be increased by?
A considerable increase in breast volume can be achieved, though this depends on the amount of adipose tissue that the patient has and, naturally, on the number of operations performed. If the patient has little superfluous adipose tissue, the volumetric increase will be modest. However, the available adipose tissue can be used to correct any asymmetry and to improve the shape of the breast, for example by widening the base or filling areas where the volume is insufficient.
In Adipofilling®, can the cellular suspension be enriched with stem cells?
Yes, quite easily. Stem cells can be isolated by centrifuging a portion of the cellular suspension for five minutes at the lowest speed of the centrifuge. A thin white layer of stromal cells will be seen to form at the distal end of the syringe; these cells contain the stem cells.
Once the stem cells have been isolated, what has to be done?
The layer that forms at the end of the syringe has to be mixed with the non-centrifuged cellular suspension; this is done by means of a connecting tube. The stromal cells obtained by means of minimum-velocity centrifugation are used, together with the adipocytes, for small corrections, for example corrections of the nose.
Are stem cells often added?
We have never used them in breast procedures. We do not think it is advantageous to stimulate the breast tissue excessively
How is the washing of the lobular fat lipoaspirate carried out?
An erlenmeyer flask equipped with a tap is used and the lobules are washed until the Ringer solution becomes colourless.
What are the “tricks of the trade” in this operation?
The fat must be drawn off through a large-calibre cannula at a low aspiration pressure; it must then be thoroughly washed, carefully fragmented with the Adipopimer® and uniformly spread in the subcutaneous tissue. The Adipopimer® is used only once; in this way, ideal fragmentation is always obtained.
Why does the fat have to be drawn off through a large-calibre cannula?
A large-calibre cannula causes less damage to the adipose cells than a small-calibre cannula
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