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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_577_Библиотеки_им_академика_М_И_Перельмана
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T.-M. Lin et al.
a
b
Fig. 12.18 This 40-year-old woman presented with breast asymmetry
(the right breast smaller than the left, especially the lower pole) and
right inverted nipple along with fat grafting. A single session of MAFT
was performed for breast enlargement (R’t deep and supercial layer/
L’t deep and supercial layer, 160mL and 65mL/150mL and 30mL,
respectively, and 30mL for the right inverted nipple). After 7years of
follow-up, nice breast contouring with sustainable volume was noted.
The inverted nipple correction also showed satisfactory long-term
results (left/right: pre-/post-MAFT) (a: AP view, b: oblique view, c:
lateral view)
12 The Legacy ofMicro-Autologous Fat Transplantation: AReality fromEvidence-Based Medicine
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c
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Fig. 12.18 (continued)
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a
b
Fig. 12.19 This 30-year-old woman underwent the MAFT procedure,
and water-jet assisted liposuction for the improvement of her breast
size. In addition, a single session of MAFT was performed for breast
enlargement (R’t deep and R’t supercial layer/L’t deep and L’t super-
cial layer, 180mL and 140mL/180mL and 140mL, respectively). At
4years and 5months of follow-up, the breast contour was well maintained with acceptable volume (left/right: pre-/post-MAFT) (a: AP
view, b: oblique view, c: lateral view)
12 The Legacy ofMicro-Autologous Fat Transplantation: AReality fromEvidence-Based Medicine
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c
149
Fig. 12.19 (continued)
150
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b
Fig. 12.20 This 35-year-old woman presented with hypoplastic
breasts and grade II ptosis. In the rst session, the MAFT procedure
was performed with water-jet-assisted liposuction. A total of
360mL/360 mL of fat was transplanted in the right and left breasts.
After 8months, another MAFT was performed (230mL/360 mL fat
transplantation for the right and left breasts, respectively) along with
nippleplasty. After 2years and 3months of both sessions, the breast
contour was well maintained with good projection and fullness (left/
right: pre-/post-MAFT) (a: AP view, b: oblique view, c: lateral view)
12 The Legacy ofMicro-Autologous Fat Transplantation: AReality fromEvidence-Based Medicine
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c
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Fig. 12.20 (continued)
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a
b
Fig. 12.21 This 37-year-old woman wanted enlargement of her
breasts. In the rst session, the MAFT procedure was performed with
water-jet- assisted liposuction. The total fat volume transplanted was
220mL/220mL in the right and left breasts, respectively, at the rst
session. After 20 months, another touchup MAFT was performed
(150 mL/140 mL fat transplantation for the right and left breasts,
respectively) along with nippleplasty. After 6months of the second procedure, the breast contour was well maintained with good projection
and fullness (left/right: pre-/post-MAFT) (a: AP view, b: oblique view,
c: lateral view)
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c
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Fig. 12.21 (continued)
12.6 Discussion
In 1893 [1], Neuber concluded that “Nach meiner Erfahrung
heilen Fettstüchchen, welche die Grösse etwa einer Bohne
oder einer Mandel übersteigen, nicht mehr ein; aber bis zu
dieser Grösse ist es mir fast immer geglückt. Je kleiner die
Stückchen, desto sicherer der Erfolg.” In my experience,
pieces of fat surpassing the size of a bean or an almond do
not heal (are not taken), but up to this size, I was nearly
always successful. The smaller the pieces, the more certain
the success. The central dogma of the MAFT technique [30]
originates from the concepts of Coleman [12] (“in some
areas, such as the eyelid, the maximum placed should be
closer to 1/30th or even 1/50th mL per withdrawal”) and
Carpaneda [13, 14]. (“The viable tissue was observed in the
peripheral zone approximately 1.5±0.5mm from the edge
of the graft.”) The MAFT concept has been accepted since
2007 [30] and was further claried by the works of
Yoshimura, “Conclusive reports of 1500μm (1.5mm) from
tissue surface (grafting edge) survived” [38, 39], and Khouri,
“The Microribbon Model predicts that, in a typical human,
fat injections larger than 0.16cm (1.6 mm) in radius will
have a region of central necrosis” [40]. Table 12.3 summarizes and highlights the concepts by conclusive mathematical
calculations and further conrms the importance of total parcel numbers in 1mL fat grafting. The injection frequency for
1mL fat should be 30–240, which is the range of MAFTGUN (60–240 triggers/mL), to obtain better clinical results.
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Table 12.3 The summarized concepts by conclusive mathematical
calculations of various theories in terms of the importance of total parcel numbers in 1mL fat grafting
No. of
Author Theory
Dr.
Carpaneda
[13, 14]
1993
Dr.
Coleman
[10–12]
2006
Dr. Khouri
[40]
2014
Dr.
Yoshimura
[38, 39]
2014
Lin etal.
(authors)
[23–33,
36, 37]
2007
1mm≦radius≦2mm
1/50mL≦parcels≦1/30mL
Microribbon,
Radius=1.6mm
Dynamic remodeling,
radius=1.5mm
MAFT (micro-autologous
fat transplantation)
technique
parcels
per 1mL
~30 1/30
30~50 1/30~1/50
58 1/58
71 1/71
60~240 1/60~1/240
Size of parcel
(mL)
12.7 Conclusions
In summary, in the modern fat grafting era, there are many
concepts to explore, techniques to rene, and research
questions to investigate. As the nal crucial step of fat
grafting and transplantation, the concept of MAFT has
shown its feasibility for clinical applications in aesthetic,
reconstructive, and regenerative surgeries and demonstrated its indispensability in fullling the concepts proposed by various authors. The application of the innovative
instrument, MAFT-GUN, fully demonstrates its implementation and proves its efcacy in facing challenges of fat
grafting in the future.
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