The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes

Background: The fat grafting process includes the 4 phases of tissue harvesting, processing, recipient-site preparation, and reinjection. Among them, the preparation of the recipient site has never been exhaustively reviewed. We aim to provide a comprehensive overview of the methods to prepare the recipient site through external expansion with the resulting outcomes. Methods: PubMed/Medline database was searched for studies on fat grafting recipient site preparation by applying the following algorithm: ((fat grafting) OR (lipofilling) OR (lipograft) AND (recipient site)). A priori criteria were used to review the resulting articles and identify those dealing with external expansion. Results: Fourteen studies published from 2008 through 2016 met inclusion criteria (4 case reports, 6 retrospective, and 4 prospective studies), representing 1,274 treated patients. Two devices for preexpansion were used with different protocols: BRAVA system and Kiwi VAC-6000M with a PalmPump. The 13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeon. Conclusions: External expansion and fat grafting is a promising technique for breast reconstruction and augmentation. However, due to the overall low level of evidence of the available studies, further research is needed to validate the procedure. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 8 February 2018. Received for publication November 28, 2017; accepted December 4,2017. This work has been presented in part at the 53rd Annual Meeting of the Swiss Society of Plastic, Reconstructive and Aesthetic Surgery, September 1st through 2nd, 2017, St. Moritz, Switzerland; the 66th National Congress of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery—1st Joint Meeting with the Brazilian Society of Plastic Surgery, in Modena, Italy, September 21st through 23rd, 2017; the 6th Annual Meeting of the International Society of Plastic & Regenerative Surgeons, November 17th through 19th, 2017, Dubai, United Arab Emirates; the 15th Annual Meeting of the International Federation for Adipose Therapeutics and Science, November 30th through December 3rd, 2017, Miami, Fla.; and the 9th International Conference on Regenerative Surgery, December 15th through 16th, 2017, Rome, Italy. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Dr. Oranges and J. Striebel contributed equally to this work. Carlo M. Oranges, MD, Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Spitalstrasse 21, 4031, Basel, Switzerland, E-mail: carlo.oranges@usb.ch Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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