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Breast Reconstruction with Enhanced Stromal Vascular Fraction Fat Grafting: What Is the Best Method?

Gentile P, Scioli MG, Orlandi A, Cervelli V - Plast Reconstr Surg Glob Open (2015)

Bottom Line: In enhanced SVF-treated patients treated with cells obtained by Celution system, we observed a 63% ± 6.2% maintenance of contour restoring after 1 year, compared with 39% ± 4.4% of control group.SVF cell counting indicated that Celution and Fatstem were the most efficient systems to obtain SVF cells.Celution and Fatstem were the 2 best automatic systems to obtain SVF and to improve maintenance of fat volume and prevent the reabsorption.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Tor Vergata University of Rome, Rome, Italy; and Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.

ABSTRACT

Background: Actually, there are 2 main methods to obtain stromal vascular fraction (SVF): enzymatic digestion and mechanical filtration; however, the available systems report heterogeneous and sometimes not univocal results. The aim of this study is to evaluate different procedures for SVF isolation and compare their clinical efficacy in the treatment of soft-tissue defects in plastic and reconstructive surgery. The authors evaluated Celution and Medikhan, enzymatic systems, and Fatstem and Mystem system, mechanical separation systems.

Methods: Fifty patients affected by breast soft-tissue defects were treated in the Plastic and Reconstructive Surgery Department of Tor Vergata University of Rome. Four groups of 10 patients were managed with enhanced SVF fat grafts using cells obtained by Celution (Cytori Therapeutics, Inc., San Diego, Calif.), Medikhan (Medi-Khan Inc., West Hollywood, Calif.), Fatstem (Fatstem CORIOS Soc. Coop, San Giuliano Milanese, Italy), and Mystem (Mystem evo Bi-Medica, Treviolo, Italy) systems. A control group of 10 patients was treated with only centrifuged fat according to Coleman's technique.

Results: In enhanced SVF-treated patients treated with cells obtained by Celution system, we observed a 63% ± 6.2% maintenance of contour restoring after 1 year, compared with 39% ± 4.4% of control group. In patients treated with SVF obtained by Medikhan system, we observed a 39% ± 3.5% maintenance, whereas enhanced SVF with Fatstem and Mystem systems gave a 52% ± 4.6% and 43% ± 3.8% maintenance of contour restoring, respectively. SVF cell counting indicated that Celution and Fatstem were the most efficient systems to obtain SVF cells.

Conclusions: Celution and Fatstem were the 2 best automatic systems to obtain SVF and to improve maintenance of fat volume and prevent the reabsorption.

No MeSH data available.


Related in: MedlinePlus

Medikhan procedure. A, Medikhan centrifuge. B, The fat (80 ml) was centrifuged at 4000 rpm for 8 minutes and placed in 60-ml syringes; extraction of syringes at the end of centrifugation. C, Collagenase, 1 ml of collagenase and 24 ml of saline solution and 25 ml of condensated fat. D, The syringe with condensated fat was enzymatically digested in the TP102 syringe Celltibator, containing 1 ml of collagenase and 24 ml of saline solution and was aseptically inserted in the incubator for the isolation of SVF by a slow centrifugation for 30 minutes at 200 rcf.
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Figure 1: Medikhan procedure. A, Medikhan centrifuge. B, The fat (80 ml) was centrifuged at 4000 rpm for 8 minutes and placed in 60-ml syringes; extraction of syringes at the end of centrifugation. C, Collagenase, 1 ml of collagenase and 24 ml of saline solution and 25 ml of condensated fat. D, The syringe with condensated fat was enzymatically digested in the TP102 syringe Celltibator, containing 1 ml of collagenase and 24 ml of saline solution and was aseptically inserted in the incubator for the isolation of SVF by a slow centrifugation for 30 minutes at 200 rcf.

Mentions: A total of 50 patients aged 19–60 years were treated from January 2013 to March 2014 at the Plastic and Reconstructive Surgery Department of “Tor Vergata” University, Rome. Ten patients affected by breast soft-tissue defects (1 patient affected by unilateral breast hypoplasia, 6 patients affected by outcomes of radiotherapy in breast cancer reconstruction, and 3 patients after prosthesis removal) were treated with SVF-enhanced autologous fat grafts obtained by Medikhan for breast reconstruction (Fig. 1). The fat (80 ml) was centrifuged at 4000 rpm for 8 minutes (Fig. 1A) and placed in 60-ml syringes. At the end of centrifugation, the authors obtained 25 ml of condensated fat (Fig. 1B) that was enzymatically digested in the TP102 syringe Celltibator, containing 1 ml of collagenase and 24 ml of saline solution (Fig. 1C). The syringe was aseptically inserted in the incubator for the isolation of SVF by a slow centrifugation for 30 minutes at 200 rcf (Fig. 1D). At the end of this procedure, the authors extracted the syringe and put the digestion obtained in a new 60-ml syringe. After extensive washing and subsequent centrifugation cycles (200 rcf for 4 minutes), the authors obtained 5 ml of solution containing SVF and added it to fat graft. To implant the fat tissue, small tunnels were previously created, forcing the cannulas of 1.5 mm diameter with accurate and controlled movements. Once the fat tissue was implanted at different levels, the access incisions were closed using 5-0 nylon stitches, and no compressive bandage was applied. It was then reinjected aseptically with a specific microcannula, using the drop-to-drop technique in small pulses (0.2–1 ml), in a radial retrograde manner, on different planes into multiple areas of the breast.


Breast Reconstruction with Enhanced Stromal Vascular Fraction Fat Grafting: What Is the Best Method?

Gentile P, Scioli MG, Orlandi A, Cervelli V - Plast Reconstr Surg Glob Open (2015)

Medikhan procedure. A, Medikhan centrifuge. B, The fat (80 ml) was centrifuged at 4000 rpm for 8 minutes and placed in 60-ml syringes; extraction of syringes at the end of centrifugation. C, Collagenase, 1 ml of collagenase and 24 ml of saline solution and 25 ml of condensated fat. D, The syringe with condensated fat was enzymatically digested in the TP102 syringe Celltibator, containing 1 ml of collagenase and 24 ml of saline solution and was aseptically inserted in the incubator for the isolation of SVF by a slow centrifugation for 30 minutes at 200 rcf.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494476&req=5

Figure 1: Medikhan procedure. A, Medikhan centrifuge. B, The fat (80 ml) was centrifuged at 4000 rpm for 8 minutes and placed in 60-ml syringes; extraction of syringes at the end of centrifugation. C, Collagenase, 1 ml of collagenase and 24 ml of saline solution and 25 ml of condensated fat. D, The syringe with condensated fat was enzymatically digested in the TP102 syringe Celltibator, containing 1 ml of collagenase and 24 ml of saline solution and was aseptically inserted in the incubator for the isolation of SVF by a slow centrifugation for 30 minutes at 200 rcf.
Mentions: A total of 50 patients aged 19–60 years were treated from January 2013 to March 2014 at the Plastic and Reconstructive Surgery Department of “Tor Vergata” University, Rome. Ten patients affected by breast soft-tissue defects (1 patient affected by unilateral breast hypoplasia, 6 patients affected by outcomes of radiotherapy in breast cancer reconstruction, and 3 patients after prosthesis removal) were treated with SVF-enhanced autologous fat grafts obtained by Medikhan for breast reconstruction (Fig. 1). The fat (80 ml) was centrifuged at 4000 rpm for 8 minutes (Fig. 1A) and placed in 60-ml syringes. At the end of centrifugation, the authors obtained 25 ml of condensated fat (Fig. 1B) that was enzymatically digested in the TP102 syringe Celltibator, containing 1 ml of collagenase and 24 ml of saline solution (Fig. 1C). The syringe was aseptically inserted in the incubator for the isolation of SVF by a slow centrifugation for 30 minutes at 200 rcf (Fig. 1D). At the end of this procedure, the authors extracted the syringe and put the digestion obtained in a new 60-ml syringe. After extensive washing and subsequent centrifugation cycles (200 rcf for 4 minutes), the authors obtained 5 ml of solution containing SVF and added it to fat graft. To implant the fat tissue, small tunnels were previously created, forcing the cannulas of 1.5 mm diameter with accurate and controlled movements. Once the fat tissue was implanted at different levels, the access incisions were closed using 5-0 nylon stitches, and no compressive bandage was applied. It was then reinjected aseptically with a specific microcannula, using the drop-to-drop technique in small pulses (0.2–1 ml), in a radial retrograde manner, on different planes into multiple areas of the breast.

Bottom Line: In enhanced SVF-treated patients treated with cells obtained by Celution system, we observed a 63% ± 6.2% maintenance of contour restoring after 1 year, compared with 39% ± 4.4% of control group.SVF cell counting indicated that Celution and Fatstem were the most efficient systems to obtain SVF cells.Celution and Fatstem were the 2 best automatic systems to obtain SVF and to improve maintenance of fat volume and prevent the reabsorption.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Tor Vergata University of Rome, Rome, Italy; and Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.

ABSTRACT

Background: Actually, there are 2 main methods to obtain stromal vascular fraction (SVF): enzymatic digestion and mechanical filtration; however, the available systems report heterogeneous and sometimes not univocal results. The aim of this study is to evaluate different procedures for SVF isolation and compare their clinical efficacy in the treatment of soft-tissue defects in plastic and reconstructive surgery. The authors evaluated Celution and Medikhan, enzymatic systems, and Fatstem and Mystem system, mechanical separation systems.

Methods: Fifty patients affected by breast soft-tissue defects were treated in the Plastic and Reconstructive Surgery Department of Tor Vergata University of Rome. Four groups of 10 patients were managed with enhanced SVF fat grafts using cells obtained by Celution (Cytori Therapeutics, Inc., San Diego, Calif.), Medikhan (Medi-Khan Inc., West Hollywood, Calif.), Fatstem (Fatstem CORIOS Soc. Coop, San Giuliano Milanese, Italy), and Mystem (Mystem evo Bi-Medica, Treviolo, Italy) systems. A control group of 10 patients was treated with only centrifuged fat according to Coleman's technique.

Results: In enhanced SVF-treated patients treated with cells obtained by Celution system, we observed a 63% ± 6.2% maintenance of contour restoring after 1 year, compared with 39% ± 4.4% of control group. In patients treated with SVF obtained by Medikhan system, we observed a 39% ± 3.5% maintenance, whereas enhanced SVF with Fatstem and Mystem systems gave a 52% ± 4.6% and 43% ± 3.8% maintenance of contour restoring, respectively. SVF cell counting indicated that Celution and Fatstem were the most efficient systems to obtain SVF cells.

Conclusions: Celution and Fatstem were the 2 best automatic systems to obtain SVF and to improve maintenance of fat volume and prevent the reabsorption.

No MeSH data available.


Related in: MedlinePlus