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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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A. Di Giuseppe and F. Giovagnoli
24.8 Post-op Care
Dressing of breast includes a light cotton bra, which should
not be tight as fat doesn’t like compression.
The area of liposuction must be compressed with a tight
garment for 6–8weeks post op. I strongly recommend manual lymphatic massage twice a week for 6–8weeks in order
to reduce post-op swelling and improve the healing process
(Fig.24.29).
Post-op recommendations include: avoid sport intense
activity for the rst 3months post op, in order to avoid to
burn out transferred fat at the early stage. Moreover, avoid
diet that will cause partial or total absorption of the transferred fat (Fig.24.30). Images show pre- and post-op comparison of the patient presented in this step-by-step fat
harvesting using REVOLVE™ System and breast
enhancement.
Patient had at the same time fat transfer to reshape
and enhance her buttocks. Photos 3months post op are
shown.
In the following photos, comparison of the 3D Crisalix
planning and the nal result is presented (Fig.24.31).
Reality is always better than a computer planning simulation. It is difcult for a computer image system to give an
idea of the soft natural looking result of breast enhanced with
fat transfer. In my experience, I now use the 3D Crisalix system only for breast augmentation, where is shown to be an
effective predictable device, but I drop it use in fat transfer
patients, as planning is not reliable according to the nal
results achieved in reality.
Final body contouring shaping is the second must and
goal to be achieved: circumferential thigs, abdomen, anks,
and posterior buttocks have been reduced and recontoured.
Even supercial buttock cellulitis has been corrected by
nanograft (Fig.24.32).
Recently, I have introduced in my practice BeautiFill
Alma Laser lipolysis. It is a laser-assisted liposuction that
allows simultaneous lasing and suction, increases skin tightening, and reduces blood loss.
It utilizes a 1470nm wavelength, with radial initial bers,
provide reduced treatment time, reduced thermal energy, and
allows collection of high vitality fat with immediate fat grafting (Fig.24.33).
Lipolife device includes (1) an inltration of peristaltic
pump with speed selection, (2) aspiration system with a rate
selection, (3) a power setting in Watts (0.15 W), (4) total
energy delivered countered, and (5) liposense temperature
control.
I’ve started utilizing BeautiFill device for liposuction and
fat transfer only in the last year.
In my experience, main advantage of the tool is the capability of a fast emulsication and collection of ready for
transfer fat. Emulsied fat is aspirated in a canister with a
microlter: after decanting, fat is collected with 50–60 cc
Luer-Lock syringes. To follow, it is further transferred to
10mL syringes ready for fat transfer into breast (Fig.24.34).
This is an example of application of BeautiFill fat transfer
device in breast augmentation. The following photos are
related to a 33 years old patient post partum breast asymmetry, empty breast with right-sided breast bigger than left.
Fig. 24.29 Post-op light cotton bra and post-op compression garment. (Courtesy of Marena ComfortWear, Marena Group LLC, The Riverside
Company)
24 Breast Fat Augmentation. Step-by-Step Technique andUltrasound Assisted Liposuction for Contouring ofDonor Area
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Fig. 24.30 24-year-old girl presenting with breast asymmetry of shape and sides, poor cleavage, cup A-B size. Breast fat augmentation, 360mL
for side added. Full C cup achieved, natural looking breast, undetectable surgical result, 3months post surgery
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A. Di Giuseppe and F. Giovagnoli
Fig. 24.31 Crisalix 3D imaging pre op planning and pre- and post-op 3months reality pictures
Planning to remove fat from abdomen, anks, and inner
thighs, to be transferred into breast for enhancement
(Fig.24.35).
After inltration of the donor areas with tumescent solution, fat is emulsied through laser ber and at the same time
suctioned into the special canister, where is collected, concentrated, and decanted (Fig.24.36).
Canister contains up to 1000mL of emulsied fat: after
proper decanting, fat is transferred into 50 mL syringes.
Ready for fat enhancement (Fig.24.37). A total of 650mL is
harvested in this case.
This procedure allows a fast fat emulsication and simultaneous fat harvesting, which rather reduces the total time of
surgery. Quality of fat, on the other side, is rather liquid.
Which means around 30% of the fat transferred is not concentrated and will be lost in the rst weeks by reducing the
liquid and swelling component.
I need long follow-up terms to give a nal judgment about
this new technology. My impression is that the cannister provided by Alma Laser can be improved, eventually with a
spinning system to help clearing extra uids.
But the survival rate reported by Levenberg and coauthors [10] is around 95% (see Fig.24.38).
This is the comparison of pre op and immediately post-op
appearance after liposuction and fat harvesting from multiple
areas and 350–300mL of fat to breasts (Figs.24.39 and 24.40).
24 Breast Fat Augmentation. Step-by-Step Technique andUltrasound Assisted Liposuction for Contouring ofDonor Area
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Fig. 24.32 24-year-old girl pre- and post-op body contouring and fat transfer to breast and buttocks. 3850mL of fat aspirated, 1400mL of fat
harvested with REVOLVE. 720mL of fat for breast enhancement and 700mL for buttock enhancement
Fig. 24.33 Lipolife device
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Fig. 24.34 Canister
A. Di Giuseppe and F. Giovagnoli
Fig. 24.36 Canister containing up to 1000mL of emulsied fat
Fig. 24.35 33-year-old patient with breast asymmetry. Pre op and markings
24 Breast Fat Augmentation. Step-by-Step Technique andUltrasound Assisted Liposuction for Contouring ofDonor Area
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Fig. 24.37 13 syringes with 50mL of fat ready for transferring (total
650mL)
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Fig. 24.38 Immediate post-op result after fat transfer (350mL in right side and 300mL in left side)
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Fig. 24.39 Before and immediately post op fat transfer to breasts
A. Di Giuseppe and F. Giovagnoli
Fig. 24.40 Before and after
buttocks and outer thigh
liposuction
24 Breast Fat Augmentation. Step-by-Step Technique andUltrasound Assisted Liposuction for Contouring ofDonor Area
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24.9 Clinical Cases
In the period 2012–2020, 440 patients underwent breast fat
augmentation.
Average age of patients varies from 18 to 62years.
Range of fat injected varies from 70 to 750mL of fat for
each side.
Main donor areas were: upper and lower abdomen, anks,
torso, lower arms, outer thigh, inner thigh, anterior thigh, and
knees.
Maximum volume aspirated was 7.5L.
Long-term follow-up varies from 6months to 5years.
All patients had pre-op breast ultrasound performed:
patients with broadenoma, suspicious lump, past medical
history of strong hereditary breast cancer, unsuitable patients
as for lacking good donor area were not considered.
Patients with unreasonable expectation, in terms of nal
size or nal shape, or projection, were not considered.
Patients with ptosis grade 2–3 or more were not considered as well.
In the past 3 years, hybrid breast augmentation with
implants and hybrid mastopexy were performed, but those
issues will be treated in different chapters.
24.9.1 Case Number 1
300mL and 360mL of fat transferred to right and left side in
a mild asymmetry. 1-year post-op result that shows quite
total persistence of fat transferred.
VASER and REVOLVE system utilized in this patient
(Fig.24.41).
24.9.2 Case Number 2
24-year-old patient, with mild asymmetry. 355 mL and
330mL of fat transferred to match the two breasts.
Fat harvested from anks and outer and inner thigh.
1-year post-op result that shows quite total persistence of fat
transferred.
VASER and REVOLVE system utilized in this patient
(Fig.24.42).
24.9.3 Case Number 3
48-year-old patient, with mild ptosis and hypotrophy of both
breasts post partum and breast feeding. Was looking for a
natural result, refused implants, not willing high projected
breast.
400mL and 400mL of fat transferred in total.
Fat harvested from anks, outer and inner thigh and pos-
terior anks and torso.
1-year post-op result that shows quite total persistence of
fat transferred.
VASER and REVOLVE system utilized in this patient
(Fig.24.43).
24.9.4 Case Number 4
35-year-old patient, with mild ptosis and emptiness on the
top of breasts. Was looking for a natural result, refused
implants, mainly looking for a top breast fullness.
360mL and 360mL of fat transferred in total.
Fat harvested from anks, outer and inner thigh and pos-
terior anks and torso.
1-year post-op result that shows quite total persistence of
fat transferred.
VASER and REVOLVE system utilized in this patient
(Fig.24.44).
24.9.5 Case Number 5
52-year-old patient, with empty breasts but with nipples still
in good position. Was looking for a natural result, refused
implants, mainly looking for a full breast fullness
enhancement.
250mL and 250mL of fat transferred in total. Fat har-
vested from anks and posterior anks and torso.
1-year post-op result that shows quite total persistence of
fat transferred.
VASER and REVOLVE system utilized in this patient
(Fig.24.45).
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Fig. 24.41 28-year-old girl, mild breast asymmetry, fat transfer to breast, fat harvested from abdomen and anks
24 Breast Fat Augmentation. Step-by-Step Technique andUltrasound Assisted Liposuction for Contouring ofDonor Area
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Fig. 24.42 24-year-old girl, mild breast asymmetry, fat transfer to breast, fat harvested from anks and outer and inner thighs
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