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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

SVF cell counting. A, Graph bar showing SVF cell yield obtained by different isolation methods: Celution, Medikhan, Fatstem, and Mystem systems. B, Graph bar of fat graft maintenance obtained by different isolation methods: Celution, Medikhan, Fatstem, and Mystem systems.
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Figure 5: SVF cell counting. A, Graph bar showing SVF cell yield obtained by different isolation methods: Celution, Medikhan, Fatstem, and Mystem systems. B, Graph bar of fat graft maintenance obtained by different isolation methods: Celution, Medikhan, Fatstem, and Mystem systems.

Mentions: In patients treated with SVF-enhanced autologous fat grafts obtained by Celution (see Supplemental Fig. 2A, Supplemental Digital Content 2, which shows the preoperative situation of patient affected by bilateral breast hypoplasia in frontal projection, http://links.lww.com/PRSGO/A100), the authors observed a 63% + 6.2% maintenance of contour restoring and 3-dimensional volume after 1 year (see Supplemental Fig. 2C, Supplemental Digital Content 2, which shows the postoperative situation after 12 months and after 1 treatment based on the use of e-SVF in frontal projection, http://links.lww.com/PRSGO/A100) compared with only 39% + 4.4% of the control group treated with fat graft centrifuged (P < 0.0001). In patients treated with SVF-enhanced autologous fat grafts obtained by Medikhan, the authors observed the same maintenance of contour restoring and 3-dimensional volume of the control group (39% + 3.5%). In patients treated with SVF-enhanced autologous fat grafts obtained by Fatstem, a 52% + 4.6% maintenance of contour restoring and 3-dimensional volume was noted (P < 0.001)(see Supplemental Fig. 1A, Supplemental Digital Content 1, which shows a preoperative situation of patient affected by bilateral breast hypoplasia in frontal projection; Supplemental Fig. 1B shows the postoperative situation after 12 months and after 1 treatment based on the use of e-SVF in frontal projection; Supplemental Fig. 1C shows the preoperative situation in ¾ right projection; Supplemental Fig. 1D shows the postoperative situation in ¾ right projection after 12 months, http://links.lww.com/PRSGO/A99). In patients treated with SVF-enhanced autologous fat grafts obtained by Mystem, the authors observed a 43% + 3.8% maintenance of contour restoring and 3-dimensional volume. The authors reported the results in Figure 5B. Transplanted fat tissue reabsorbing was analyzed with instrumental imaging (MRI-ultrasound). In patients affected by soft-tissue defects of the breast, reconstruction with SVF-enhanced fat tissue obtained by Celution and Fatstem showed a lower fat reabsorbing. All patients were satisfied with the resulting texture, softness, contour, and MRI (see Supplemental Fig. 2B, Supplemental Digital Content 2, which shows the MRI, preoperative situation; Supplemental Fig. 2D, which shows the MRI, postoperative situation after 12 months, http://links.lww.com/PRSGO/A100) and confirmed the percentage of resorption. The images were acquired on axial and sagittal planes. Based on MRI scans acquired, volumetric assessments of the breasts were also calculated, taking as edges the anterior axillary line, anterior margin of the pectoral muscle, mediosternal line, skin, and nipple.


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)

SVF cell counting. A, Graph bar showing SVF cell yield obtained by different isolation methods: Celution, Medikhan, Fatstem, and Mystem systems. B, Graph bar of fat graft maintenance obtained by different isolation methods: Celution, Medikhan, Fatstem, and Mystem systems.
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Related In: Results  -  Collection

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

Figure 5: SVF cell counting. A, Graph bar showing SVF cell yield obtained by different isolation methods: Celution, Medikhan, Fatstem, and Mystem systems. B, Graph bar of fat graft maintenance obtained by different isolation methods: Celution, Medikhan, Fatstem, and Mystem systems.
Mentions: In patients treated with SVF-enhanced autologous fat grafts obtained by Celution (see Supplemental Fig. 2A, Supplemental Digital Content 2, which shows the preoperative situation of patient affected by bilateral breast hypoplasia in frontal projection, http://links.lww.com/PRSGO/A100), the authors observed a 63% + 6.2% maintenance of contour restoring and 3-dimensional volume after 1 year (see Supplemental Fig. 2C, Supplemental Digital Content 2, which shows the postoperative situation after 12 months and after 1 treatment based on the use of e-SVF in frontal projection, http://links.lww.com/PRSGO/A100) compared with only 39% + 4.4% of the control group treated with fat graft centrifuged (P < 0.0001). In patients treated with SVF-enhanced autologous fat grafts obtained by Medikhan, the authors observed the same maintenance of contour restoring and 3-dimensional volume of the control group (39% + 3.5%). In patients treated with SVF-enhanced autologous fat grafts obtained by Fatstem, a 52% + 4.6% maintenance of contour restoring and 3-dimensional volume was noted (P < 0.001)(see Supplemental Fig. 1A, Supplemental Digital Content 1, which shows a preoperative situation of patient affected by bilateral breast hypoplasia in frontal projection; Supplemental Fig. 1B shows the postoperative situation after 12 months and after 1 treatment based on the use of e-SVF in frontal projection; Supplemental Fig. 1C shows the preoperative situation in ¾ right projection; Supplemental Fig. 1D shows the postoperative situation in ¾ right projection after 12 months, http://links.lww.com/PRSGO/A99). In patients treated with SVF-enhanced autologous fat grafts obtained by Mystem, the authors observed a 43% + 3.8% maintenance of contour restoring and 3-dimensional volume. The authors reported the results in Figure 5B. Transplanted fat tissue reabsorbing was analyzed with instrumental imaging (MRI-ultrasound). In patients affected by soft-tissue defects of the breast, reconstruction with SVF-enhanced fat tissue obtained by Celution and Fatstem showed a lower fat reabsorbing. All patients were satisfied with the resulting texture, softness, contour, and MRI (see Supplemental Fig. 2B, Supplemental Digital Content 2, which shows the MRI, preoperative situation; Supplemental Fig. 2D, which shows the MRI, postoperative situation after 12 months, http://links.lww.com/PRSGO/A100) and confirmed the percentage of resorption. The images were acquired on axial and sagittal planes. Based on MRI scans acquired, volumetric assessments of the breasts were also calculated, taking as edges the anterior axillary line, anterior margin of the pectoral muscle, mediosternal line, skin, and nipple.

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