Background: The viability of fat grafts obtained by even a well-established technique remains poorly studied and unknown. This study was designed to determine the viability of fat grafts harvested and refined by the Coleman technique.Methods: Sixteen adult white women were enrolled in this study. In group 1 (n = 8), fat grafts were harvested and processed with the Coleman technique by a single surgeon from the abdomen of each patient according to his standardized method. In group 2 (n = 8), fat grafts were harvested with the conventional liposuction by another surgeon. After centrifugation, the resulting middle layer of tissue was collected. All fat graft samples were analyzed for the following studies: trypan blue vital staining for viable adipocyte counts, glycerol-3-phophatase dehydrogenase assay, and routine histologic examination.
The most acceptable explanation for absorption has been based on the Peer's cell survival theory, which states that the number of viable adipocytes at the time of transplantation may correlate with ultimate fat graft survival volume.So to improve the ultimate long-term result, the technique used to harvest the fatty tissue and to implant it must be such that there is maximum cell survival.
This study compared the Coleman techniqueIn 1994, Coleman first described his technique, which uses a syringe, cannula, and centrifuge, for structural fat grafting. He later refined and popularized his technique for fat graft harvesting and processing with the Coleman instruments and centrifuge and a centrifugation protocol, often referred to as the Coleman technique. By using his established technique for fat graft harvesting and processing along with his refined placement technique, many surgeons are able to achieve good long-term results with structural fat grafting.
with traditional liposuction harvestFat grafts were harvested and processed with the Coleman technique and spun at 3000 rpm for 3 minutes according to his protocol. After centrifugation, both upper and lower levels of components were removed and the remaining fat grafts within syringes were studied subsequently.
Their result:Fat grafts were harvested with conventional liposuction and spun at 500 rpm for 10 minutes. After centrifugation, the resulting middle layer of adipose aspirates was then studied for comparison.
Even though its a small study, it looks like the Coleman method is superior than conventional liposuction for harvesting fat.In this study, the total number of viable adipocytes was 4.11 ± 1.11 × 106 cells/ml in group 1 and 2.57 ± 0.56 × 106 cells/ml in group 2. The higher viable adipocyte count was found in group 1 compared with group 2. The difference of viable adipocyte counts between the two groups was found to be statistically significant (p < 0.004).Glycerol-3-phophatase dehydrogenase assay was used in this study to assess cellular function of fat grafts in each group. The higher the enzyme activity level, the better the cellular function of adipocytes within fat grafts. The glycerol-3-phophatase dehydrogenase activity was 0.66 ± 0.09 U/ml in group 1 and 0.34 ± 0.13 U/ml in group 2. The higher level of the enzyme activity was found in group 1 compared with group 2. The difference of glycerol-3-phophatase dehydrogenase assay between the two groups was found to be significantly significant (p < 0.0001).There was no evidence of fatty tissue degeneration or necrosis in either group. Normal structure of fragment fatty tissues was found primarily, and the basic structure of fragmental fatty tissues appeared to be maintained in both groups. No distinguishable differences were seen histologically in group 1 compared with group 2.
Second article: Fat for Breast: Where are We? (editorial) by Scott Spear, MD (only portions)
Autologous fat injection in general has achieved wide acceptance over the past decade or two. It is widely used by surgeons for face, buttock, hand, and postliposuction deformities. Its use in the breast has proceeded more slowly, perhaps for good reason. The breast can be augmented or reconstructed in most cases relatively easily with implants or flaps. It is important to remember that for reasons of disease detection, the breast is subjected to frequent radiologic and physical examinations, and greater than 10 percent of women eventually develop breast cancer. Thus, mimicking breast cancer, obscuring breast cancer, or causing breast cancer are issues that surround any breast procedure or device, particularly fat infiltration.As we assess the value proposition of breast fat infiltration, we need to distinguish five different scenarios and assess them individually. Those five scenarios are:1. Supplementing breast reconstruction by improving contour irregularities.
2. Correcting defects after lumpectomy or other partial injuries.
3. Cosmetic breast enhancement and enlargement.
4. Camouflaging implants after breast augmentation.
5. Reconstruction after mastectomy using solely fat infiltration.
As scientific investigations go, we are relatively early in looking into this subject. As we attempt to arrive at our conclusions, I suggest that we measure and examine five factors for each of these potential applications: efficacy, safety, cost, value/work, and liability.
I have not even had good long term results with lip augmentation (we’re talking small volume of fat grafts needed), so why should I expect to have them with breast fat grafting? So for now, I’ll stick to what is predictable results for me. I will be watching the studies and techniques though.The average surgeon's fee for implants is about $4,000 and for liposuction about $3,000, according to the American Society of Aesthetic Plastic Surgery. But breast augmentation with fat injections can cost about $20,000, Coleman says.
For any woman interested in being in one of the two clinical trials, you can find the information on the federal clinical trials Web site.
One, led by Scott Spear, MD, chief of plastic surgery at Georgetown University Hospital in Washington, D.C., is seeking 20 women, aged 20 to 50, to undergo liposuction and fat grafting to augment their breasts.
REFERENCESAnother, led by Roger Khouri, MD, a Miami plastic surgeon, will study augmentation with fat in combination with the use of the Brava system. The system includes semi-rigid domes worn over the breasts for several hours a day to induce breast tissue growth before the injections are done.
Autologous Fat Grafts Harvested and Refined by the Coleman Technique: A Comparative Study; Plast. Reconstr. Surg. 122(3):932-937, September 2008; Pu, Lee L. Q. M.D., Ph.D.; Coleman, Sydney R. M.D.; Cui, Xiangdong M.D.; Ferguson, Robert E. H. Jr M.D.; Vasconez, Henry C. M.D.
Fat for Breast: Where are We? (editorial); Plast. Reconstr. Surg. 122(3), September 2008, pp 983-984; Spear, Scott L. MD
Are Fat Injections Safe for Breasts? by Kathleen Koheny; WebMD Health News, Oct 22, 2008