Brustaugmentation mit autologem Fett – Erfahrungen aus 96 Operationen mit der BEAULI^TM-Methode

Zusammenfassung

In den letzten 30 Jahren hat das Interesse an einer Verwendung des körpereigenen Fettes zur ästhetischen Körperformung, speziell zur Augmentation der weiblichen Brust, kontinuierlich zugenommen. Fehlende Fremdkörperreaktionen, harmonisches Aussehen und ein natürliches Gefühl sind die Vorteile einer autologen Fettzell-Transplantation. Komplikationen wie Nekrosen, Infekte, Zystenbildungen, hohe Graftverluste sowie die Schwierigkeit, große Fettmengen in vernünftiger Zeit zu gewinnen boten in früheren Jahren Ansatz zu Kritik an der Methode des Eigenfett-Transfers. Mit der BEAULI™-Methode steht seit 2007 ein Verfahren zur rationellen Gewinnung und Aufbereitung größerer transplantabler Fettmengen zur Verfügung. Das Ziel dieser Arbeit ist es, die Operationstechnik präzise und reproduzierbar zu beschreiben sowie aufgrund eigener klinischer Erfahrungen einen umfassenden Überblick über den autologen Fetttransfer zu vermitteln. Zwischen dem 1. September 2010 und dem 30. Juni 2012 führte der Autor 96 Eigenfett-Transplantationen an 84 Patientinnen durch. Ausgewählt wurden Patientinnen zwischen 18 und 62 Jahren mit dem Wunsch nach einer moderaten Volumenvermehrung und Formung der Brüste. Die Fettgewinnung erfolgte mittels wasserstrahl-assistierter Liposuction (Bodyjet™) und anschließender Separierung der Fettzellen mit dem LipoCollector™. Postoperativ traten in keinem Fall Komplikationen auf. Die Resultate wurden im Rahmen einer Kontrolluntersuchung, eines Fotovergleichs und in der Beantwortung eines Fragebogens beurteilt. Bezüglich des Volumengewinns bzw. der Formverbesserung der Brüste waren 35% der Patientinnen mit dem Ergebnis sehr zufrieden, 42% zeigten sich zufrieden, 22% hätten sich noch mehr Volumen gewünscht, 1% war unzufrieden. Diese Studie zeigt, dass die autologe Fettzell-Transplantation in die weibliche Brust mit der BEAULI™-Methode eine gute und sichere Methode ist, bei ausgewählten Patientinnen eine moderate und harmonische wirkende Brustvolumenvergrößerung sowie eine nachhaltige und natürliche wirkende Konturverbesserung zu erzielen. Weitere Studien mit hohen Fallzahlen und Beobachtungszeiten über mehrere Jahre sowie Guidelines der Fachgesellschaften könnten dazu beitragen, die Methode des Eigenfett-Transfers bezüglich Einheilungsrate, Effizienz und Sicherheit zu perfektionieren.

Abstract

Over the past 30 years, interest in the use of autologous fat for aesthetic body contouring, especially for breast augmentation has been continuously on the rise. The benefits of an autologous fat transplant include the absence of any inflammatory reaction to a foreign body, its harmonious appearance and a natural feeling. In earlier years, complications such as necrosis, infections or the formation of cysts, poor resorption rates as well as the difficulty of harvesting large amounts of fat within a reasonable amount of time provided grounds for criticism of the methodology of autologous fat transplanta­tion. With the advent of the so-called BEAULI™ method, since 2007 a procedure is available for the efficient harvesting and processing of larger quantities of transplantable fat. The aim of the study is to describe the technique in detail and reproducibly and to present a detailed overview of autologous fat transfer due to the basis of our own clinical experience. Between 1 September 2010 and 30 June 2012 the author performed 96 fat transfer procedures on 84 patients. Patients aged 18–60 with a desire for a moderate augmentation of volume and shape of the breasts were selected for the procedure. The fat was harvested using water jet-assisted liposuction (Bodyjet™) to flush out the fat cells and subsequent separation of the fat components with the LipoCollector™. There were no occurrences of post-operative complications in any of the cases. The results were evaluated in the context of a check-up, a photographic comparison and with the completion of a questionnaire. With regard to the increase in size and/or shape enhancement of the breasts, 31% of the patients were very happy with the results, 45% indicated they were satisfied, 23% would have liked more volume, while 1% were dissatisfied. This study indicates that the autologous fat transplant into the female breast using the BEAULI™ method represents an excellent, safe method for the achievement of a moderate and harmonious breast size augmentation as well as sustainable and natural-looking contour improvements in selected patients. Additional studies with a larger number of cases and longer observation periods over several years as well as guidelines from the professional associations could contribute to the further perfection of the autologous fat transplant method in terms of resorption rate, efficiency and safety.

Schlüsselwörter

Brustaugmentation - autologer Fetttransfer - BEAULI - Liposuction

Key words

breast augmentation - autologous fat graft - BEAULI - liposuction

• Literatur

• 1 Illouz YG, Sterodimas A. Autologous Fat Transplantation to the Breast: A Personal Technique with 25 Years of Experience. Aesth Plast Surg 2009; 33: 706-715
• 2 Coleman SR, Saboeiro AP. Fat Grafting to the Breast Revisited: Safety and Efficacy. Plast Reconstr Surg 2007; 119: 775-785
• 3 Coleman SR. Structural Fat Grafting. Aesthet Surg J 1998; 18: 386-388
• 4 Ueberreiter K, von Finckenstein JG, Cromme F et al. BEAULI^TM – eine neue Methode zur einfachen und zuverlässigen Fettzell-Transplantation. Handchir Mikrochir Plast Chir 2010; 42: 379-385
• 5 Largo RD, Häcki J, Güven S et al. Autologe Fetttransplantation in die weibliche Brust. Schweiz Med Forum 2011; 11: 489-494
• 6 Ramon Y, Shoshani O, Peled IJ et al. Enhancing the Take of Injected Adipose Tissue by a Simple Method for Concentrating Fat Cells. Plast Reconstr Surg 2005; 115: 197-201
• 7 Khater R, Atanassova P, Anastassov Y et al. Clinical and Experimental Study of Autologous Fat Grafting after Processing by Centrifugation and Serum Lavage. Aesthet Plast Surg 2009; 33: 37-43
• 8 Rose Jr JG, Lucarelli MJ, Lemke BN et al. Histologic Comparison of Autologous Fat Processing Methods. Ophthal Plast Reconstr Surg 2006; 22: 195-200
• 9 Herold C, Ueberreiter K, Cromme F et al. Ist eine intramuskuläre Injektion bei autologer Fetttransplantation zur Mamma sinnvoll? – Eine MRT-volumetrische Studie. Handchir Mikrochir Plast Chir. DOI: 10.1055/s-0030-1269931
• 10 Salgarello M, Visonti G, Rusciani A. Breast Fat Grafting with Platelet-Rich Plasma: A Comparative Clinical Study and Current State of the Art. Plast Reconstr Surg 2011; 127: 2176-2185
• 11 Khouri R, Del Vecchio D. Breast Reconstruction and Augmentation using Pre-Expansion and Autologous Fat Transplantation. Clin Plast Surg 2009; 36: 269-280
• 12 Fournier PF. Fat grafting: My Technique. Dermatol Surg 2000; 26: 1117-1128
• 13 Alexander RW. Use of Platelet-Rich-Plasma to Enhance Effectiveness of Autologous Fat Grafting. In: Shiffman MA. Autologous Fat Transfer. Berlin Heidelberg: Springer; 2010: 87-112
• 14 Shiffman MA. eds. Commentary. In: Shiffman MA. Autologous Fat Transfer. Berlin Heidelberg: Springer; 2010: 463-465
• 15 Matsumoto D, Shigeura T, Sato K et al. Influence of Preservation at Various Temperatures on Liposuction Aspirates. Plast Reconstr Surg 2007; 120: 1510-1517
• 16 Keck M, Janke J, Ueberreiter K. Viability of Praeadipocytes In Vitro: The Influence of Local Aenesthetics and pH. Dermatol Surg 2009; 35: 1251-1257
• 17 Alexander RW. Autologous Fat Grafting: A Study of Residual Intracellular Adipocyte Lidocaine. In: Shiffman MA. Autologous Fat Transfer. Berlin Heidelberg: Springer; 2010: 445-450
• 18 Shiffman MA. Fat Transfer Principles. In: Shiffman MA. Body Contouring. Berlin Heidelberg: Springer; 2010: 577-585
• 19 Rohrich RI, Sorokin ES, Brown SA. In Search of Improved Fat Transfer Viability: A Quantitative Analysis of the Role of Centrifugations and Harvest Site. Plast Reconstr Surg 2004; 114: 391-395
• 20 Moore Jr JH, Kolaczynski JW, Morales LM et al. Viability of Fat Obtained by Syringe Suction Lipectomy: Effects of Local Anesthesia with Lidocaine. Aesth Plast Surg 1995; 19: 335-339
• 21 Shiffman MA. Principles of Autologous Fat Transplantation. In: Shiffman MA. Autologous Fat Transfer. Berlin Heidelberg: Springer; 2010: 11-17
• 22 Shiffman MA, Mirrafati S. Fat Tansfer Techniques: The Effect of Harvest and Transfer Methods on Adipocyte Viability and Review of the Literature. Dermatol Surg 2001; 27: 819-826
• 23 Kaminski MV, Lopez de Vaughan RM. Fat Autograft Retention with Albumin. In: Shiffman MA. Autologous Fat Transfer. Berlin Heidelberg: Springer; 2010: 123-133
• 24 Smith P, Adams Jr WP, Lipschitz AH et al. Autologous Human Fat Grafting: Effect of Harvesting and Preparation Techniques on Adipocyte Graft Survival. Plast Reconstr Surg 2006; 117: 1836-1844
• 25 Nakamura S, Ishihara M, Takikawa M et al. Platelet-Rich Plasma (PRP) Promotes Survival of Fat-Grafts in Rats. Annals of Plast Surg 2010; 65: 101-106
• 26 Yoshimura K, Sato K, Aoi N et al. Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells. Aesth Plast Surg 2008; 32: 48-55
• 27 Tabit CJ, Slack GC, Fan K et al. Fat Grafting Versus Adipose-Derived Stem Cell Therapy: Distinguishing Indications, Techniques and Outcomes. Aesth Plast Surg DOI: 10.1007/s-00266-011-9835-4.
• 28 Brayfield C, Marra K, Rubin JP. Adipose Stem Cell for Soft Tissue Regeneration. Handchir Mikrochir Plast Chir 2010; 42: 124-128
• 29 Philips BJ, Marra KG, Rubin JP. Adipose Stem Cell-Based Soft Tissue Regeneration. Expert Opinion on Biological Therapy 2012; 12: 155-163
• 30 Raskin BI. Cryopreserved Fat. In: Shiffman MA. Autologous Fat Transfer. Berlin Heidelberg: Springer; 2010: 305-311
• 31 Cotrufo S, Mandal A, Mithoff EM. Letter/Comment, Plastic and Reconstr Surgery DOI: 10.1097/01.prs.0000294957.94383.84.
• 32 Claro Jr F, Figueiredo JC, Zampar AG et al. Applicability and Safety of Autologous Fat for Reconstruction of the Breast. Brit J Surg 2012; 99: 768-780
• 33 Hyakusoku H, Ogawa R, Ono S et al. Complications after Autologous Fat Injection to the Breast. Plast Reconstr Surg 2009; 123: 360-370
• 34 Veber M, Tourasse M, Tousson G et al. Radiographic Findings after Breast Augmentation by Autologous Fat Transfer. Plast Reconstr Surg 2011; 127: 1289-1299
• 35 Coleman SR. Augmentation of the Breast with Structural Fat. In: Coleman SR. Fat Injection. From Filling to Regeneration. St. Louis: Quality Medical Publishing Inc; 2009: 503-544
• 36 Coon D, Zuley M, Toy J et al. Mammographic Changes after Stem Cell Supplemented Fat Transfer to the Breast Compared with Changes after Breast Reduction: A Blinded Study. Plast Reconstr Surg 2011; 128: 54
• 37 Rubin JP, Coon D, Zuley M et al. Mammographic Changes after Fat Transfer to the Breast Compared with Changes after Breast Reduction: A Blinded Study. Plast Reconstr Surg 2012; 129: 1029-1038
• 38 Shiffman MA. Medical Legal Aspects of Autologous Fat Transplantation. In: Shiffman MA. Autologous Fat Transfer. Berlin Heidelberg: Springer; 2010: 459-462
• 39 Rigotti G, Marchi A, Stringhini P et al. Determing the Oncological Risk of Autologous Lipoaspirate Grafting for Post-Mastectomy Breast Reconstruction. Aesth Plast Surg 2010; 34: 475-480
• 40 Fraser JK, Hedrick M, Cohen S. Oncologic Risk of Autologous Fat Grafting to the Breast. Aesth Surg J 2011; 31: 68-75