Adipose tissue capacity
Lipofilling or the transplant of fat has been of interest to aesthetic plastic surgeons for very many years, having been described for the first time more than a hundred years ago. Over time its applications and its results have not always been constant and reproducible, but, from the 1980s onwards, the progress made relative to the basic biological knowledge of adipose tissue, produced an ever greater diffusion of lipofilling, both in aesthetic surgery and in reconstructive surgery.
We have already known for some time about the “regenerative capabilities” of adipose tissue, which are linked to the presence, within the adipose tissue itself, of stem cells, that are capable of producing new cellular lines, which have opened the way to so-called regenerative medicine and to potentially extraordinary applications in reconstructive, plastic and aesthetic surgery. When we carry out lipofilling they are these particular stem cells that probably survive and are able to change themselves giving origin to living tissue. The transferred stem cells are able to form new capillary vessels (neoangiogenesis) contributing to better local growth of the tissue involved in the transplant. Therefore, lipofilling, meant as the transfer of adipose cells, but above all of stem cells, has different aims and potential: filling, restructuring and even regenerating. The filling is shown by the increase in volume, the restructuring and regenerating are highlighted by the improvements in the quality of the cutaneous and subcutaneous tissues in the case of tissues which are scarcely irrigated as in ulcerated areas, areas affected by radiodermatitis, radionecrosis and scars of various types.
As regards the breasts, lipofilling can be very useful as an integration and complement to mammary aesthetic surgery by enveloping and covering the implants, thus increasing the thickness of the subcutaneous tissue and contributing in this way in making the implants themselves less evident. It can help to make the implants less visible in the upper and lateral quarters by reducing the visibility of the implants in the areas of thin subacutis, which appears in the form of a wrinkling of the surface of the skin (“rippling”) and can make the capsular reaction around the implant softer, reducing the contraction of the capsule itself. Moreover, it can be used to correct malformations and deformities in development which appear with an imbalance in volume of a slight/moderate entity in cases in which the other breast is of a normal volume.
Lipofilling aesthetic breast surgery
Over the last twenty years and increasingly in time additive mastoplasty operations have been carried out without the use of implants. This procedure obviously requires there to be tissue available for harvesting by liposuction and has evident advantages (no foreign body, no scars, reconstitution of the volume of the breast with tissue that the breast in naturally made of), but it is right to underline that several procedures may be necessary, with intervals of months in between, to obtain the required result.
The operation is carried out under a local anaesthetic with sedation and, as in any lipofilling procedure, calls for liposuction in a donor area, the transfer of the fat that has been harvested by suction (decantation, centrifugation, purification), and the subsequent re-injection into the breast via small blunt ended cannulas. At the end of the procedure a bandage it put on that needs to be kept in place for about a week. The result can be considered stable after 3-6 months.