Fat Injection to the Breast: Technique, Results, and Indications Based on 880 Procedures Over 10 Years
Fat Injection to the Breast: Technique, Results, and Indications Based on 880 Procedures Over 10 Years
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DOI：
10.1016/j.asj.2009.08.010
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发表时间：
2009-09-01
影响因子：
2.9
通讯作者：
Sinna, Raphael
中科院分区：
文献类型：
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作者：
Delay, Emmanuel;Garson, Sebastian;Sinna, Raphael
背景：自体脂肪注射丰胸并不是一个新想法，但一直存在争议。特别是，人们担心自体脂肪隆胸可能会导致钙化和囊肿的形成，从而可能妨碍乳房X光检查以检测可能的乳腺癌。 目的：作者报告了他们在过去 10 年中进行的 880 例乳房脂肪移植（脂肪建模）的经验。他们回顾了他们的技术和结果，并描述了他们发现脂肪建模合适的各种适应症。方法：脂肪建模通常在全身麻醉下进行。脂肪是从腹部或在某些情况下从大腿内侧采集的，具体取决于患者的天然脂肪沉积。将收获的脂肪离心以获得纯化的脂肪，将其转移到10mL注射器中直接注射到乳房中。在轻压下少量注射脂肪，利用蜂窝状的微通道，并在受体组织饱和时停止，以避免形成可能导致脂肪坏死的脂肪池。为了补偿脂肪吸收，注射了 140 mL 脂肪，最终所需体积为 100 mL。 结果：临床随访表明，如果患者体重保持恒定，则脂肪建模的形态学结果在术后三到四个月内获得的体积是稳定的。术后放射学外观通常是正常乳房的外观，有时会显示脂肪坏死的图像，这对于有乳腺成像经验的放射科医生来说不会混淆癌症的鉴别诊断。术后 10 年的肿瘤学随访（对于第一批患者）显示癌症局部复发或发展为新癌症的风险没有增加。结果对患者和外科医生来说都非常满意。并发症包括 1 例采集部位感染、6 例注射部位感染以及 1 例术中气胸，但在恢复室得到成功治疗，没有出现任何后续后果。脂肪坏死的发生率为3%，大多数病例发生在外科医生的早期。结论：脂肪建模由于并发症发生率低且结果积极，为乳房整形、重建和美容手术提供了新的选择。有必要由专门从事乳腺成像的放射科医生进行术前和术后检查，以限制脂肪建模同时发生癌症的风险。 （美学外科杂志；29：360-378。）
BACKGROUND: Fat injection to the breast is not a new idea, but it has always been controversial. In particular, it has been feared that breast augmentation with autologous fat could lead to the formation of calcifications and cysts that might hinder mammagraphic examinations for detection of possible breast cancer.OBJECTIVE: The authors report their experience with fat transplantation in the breast (lipomodeling) covering 880 procedures performed over the past 10 years. They review their technique and results, and describe the various indications for which they have found lipomodeling to be appropriate.METHODS: Lipomodeling was generally performed under general anesthesia. Fat was harvested from the abdomen or in some cases from the inner thighs, depending on the patient's natural fat deposits. The harvested fat was centrifuged to obtain purified fat, which was transferred to 10-mL syringes for injection directly into the breast. Fat was injected in small quantities under light pressure, utilizing a honeycomb of microtunnels and halting when the recipient tissues were saturated to avoid creation of fatty pools that could lead to fat necrosis. To compensate for fat resorption, 140 mL of fat was injected for a desired final volume of 100 mL.RESULTS: Clinical follow-up shows that the morphologic results of lipomodeling with regard to the volume obtained are stable three to four months postoperatively if the patient's weight remains constant. The postoperative radiologic appearance is usually that of normal breasts, sometimes showing images of fat necrosis that will not confuse the differential diagnosis of cancer for radiologists experienced in breast imaging. Oncologic follow-up at 10 years postoperatively (for the first patients) showed no increased risk of local recurrence of cancer or development of a new cancer. Results were highly satisfactory for both patients and surgeons. Complications included one case of infection at the harvest site, six cases of infection at the injection site, and one case of intraoperative pneumothorax that was successfully treated in the recovery room with no later consequences. The incidence of fat necrosis was 3%, with most cases occurring early in the surgeon's experience.CONCLUSIONS: Lipomodeling, because of a low complication rate and positive results, presents a new option for plastic, reconstructive, and aesthetic surgery of the breast. Pre- and postoperative examination by a radiologist specialized in breast imaging is necessary to limit the risk that a cancer may occur coincidentally with lipomodeling. (Aesthet Surg J;29:360-378.)