Autologous Fat Transfer (Lipofilling)

What Is Lipofilling?

Lipofilling or "autologous fat transfer," as the medical term is called, means "autologous fat injection" and is an esthetic and reconstructive surgery method. Autologous fat is used to fill up the breast or buttocks' volume, improve the tissue's shape, or compensate for facial wrinkles, dents, and scars. For this purpose, the fat is removed from the abdomen, thighs, or buttocks. After the removal, the cells are prepared and inserted at the desired location with a large cannula.

Lipofilling has been used for years and is continuously being developed and improved. The use of lipofilling is now widespread for the reconstruction of the breast after breast cancer surgery. However, lipofilling is also becoming increasingly popular in cosmetic surgery. It is particularly suitable for the treatment of facial wrinkles and scars. No foreign substances such as implants, hyaluronic acid, or Botox are used, making lipofilling particularly attractive for many patients.

At Which Parts of the Body Can Autologous Fat Injection Be Applied?

Lipofilling of the breast

Lipofilling is often used to restore the breast after cancer. Deformations and dents can be easily compensated. Lipofilling can also be used for breast augmentation with the patient's own fat. In most cases, however, several procedures are necessary to achieve the desired result. For implants, a single surgery is sufficient. This method is suitable for patients who prefer a more natural result or refill the breast volume after implant removal.

Lipofilling in the Face

The small wrinkles around the mouth, frown lines between the eyes, small wrinkles around the eyes, and nasolabial folds (wrinkles on the left and right side of the nose), can be easily filled with the patient's own fat. Lips and cheeks can also be padded.

Buttocks

The buttocks can be tightened, enlarged, and padded with your own fat.

The Procedure of Lipofilling?

First, the doctor explains the procedure in detail and pays particular attention to the patient's wishes to find out if they are comprehensible and realistically achievable., He carefully examines the patient and determines the general condition and laboratory parameters before the surgery. Treatment should not be carried out if there is active cancer or acute infection in the affected tissue, during pregnancy and breastfeeding, and in the case of severe coagulation disorders. The doctor must carefully consider whether surgery can be carried out in patients with an increased risk of breast cancer (occurrence in the family, mutation of the BRCA1/2 gene), immune suppression, or heavy nicotine consumption.

Depending on the indication, the surgery is carried out in an outpatient or inpatient setting. The correct collection technique is essential for treatment success. The doctor must remove the fat cells as gently as possible so that they are not damaged during the removal. There are different techniques for this. In the "tumescent technique," the doctor first injects fluid (saline solution with the addition of an anesthetic) into the fatty tissue. In this way, fat cells are dissolved. The "water jet assisted" suction is incredibly gentle. Here, the tumescent solution is injected into the tissue under slight pressure, and the liquefied fat cells are suctioned off with the fluid. Up to 90 percent of the fat cells survive with this method. In addition to the water jet-assisted technique according to BEAULI, other techniques are recommended in the "Guidelines for Autologous Fat Transfer": Technique, according to Coleman, "Lipivage," method according to Shippert, and technique according to Khouri. The fat cells removed are separated from the blood, serum, and damaged cells, for example, by centrifugation or filtration. The preparation also plays an essential role in the quality of the transplant. After preparation, the fat cells are returned as quickly as possible. Frozen fatty tissue should not be used. The doctor distributes the fat cells to several locations in the target tissue with a blunt cannula. He injects a maximum of 0.5ml at one point to avoid great pressure on the tissue. In the breast's case, the fat cells should not be injected into the glandular tissue, but under the skin, between and under the muscles.

One day after the surgery, the doctor examines the wound and pays attention to complications such as wound infections and bruises. The patient is also regularly examined in the following weeks. If the surgery is carried out on the chest and bottom, the doctor will apply an elastic bandage. The patient should take it easy for four weeks, not do any sports, and not go to the sauna. After lipofilling in the face, swellings are cooled. Slight shaping of the transplant is still possible after the surgery. If necessary, the doctor will prescribe painkillers and anti-inflammatory drugs.

A significant problem of autologous fat transfer is that many transplanted fat cells do not survive. Therefore, a procedure called "cell-assisted autologous fat transplantation" has been developed to improve the fat cells' regenerative capacity. Mesenchymal stem cells are found in the fatty tissue. If fat cells die, new fat cells are created from these stem cells. In this way, the fat tissue can renew itself again and again.

In cell-assisted autologous fat transplantation, the transplant is enriched with mesenchymal stem cells to improve transplanted fat tissue's regenerative capacity. This is intended to counteract the high fat cell loss during treatment. After removing adipose tissue, mesenchymal stem cells are isolated from a part of the adipose tissue using a particular purification procedure. These isolated stem cells are added to the actual fat tissue transplant. The transplant has a higher concentration of stem cells than normal fatty tissue. So far, little research has been done into this method. There is no proof of an advantage over conventional lipofilling, and there are still no studies that prove the technique's safety. Therefore, the cell-assisted method should only be used in strictly controlled clinical studies for the time being.

How Long Does Lipofilling Last?

Many of the transplanted fat cells do not grow; they are resorbed or die. Depending on the method, a high-volume loss of between 25 and 90 percent is expected within the first three months after the surgery! Even with small amounts of transplanted fat cells, for example, long-term losses of up to 70 percent are reported when injecting wrinkles.

The actual success of the treatment is not visible until three months after the surgery. It depends significantly on the method used and the proper procedure of the surgery! The result, after three months, is permanent unless the patient generally suffers a significant weight loss. In this case, the body regions treated with lipofilling are also affected. If a repeated treatment is necessary, it should be carried out after three months at the earliest.

What Are the Risks?

After the treatment, the following complications are possible:

• Infections
• Hematoma
• Swelling
• Scarring
• Contour irregularities
• Overcorrection or under-correction of deformities
• Minor bleeding
• High volume loss
• Individual cases of fat embolism (occlusion of blood vessels by fat drops), stroke, and meningitis caused by fat cells

Breast surgery can also lead to calcification of the tissue and oil cysts (cavities filled with fat). These complications occur just as often during other breast surgeries. Rarely does an injury during surgery result in a pneumothorax, which means air gets between the lungs and the ribs.

Edema, bruising, scars, hypersensitivity, pigmentation disorders, itching, and infection-related skin necrosis can occur where the fat was removed.

In breast cancer patients, diagnosis with imaging techniques is more difficult after autologous fat treatment. Conclusive mammography can be performed six months after fat transplantation at the earliest. There is a risk that a recurrence of the tumor will not be detected in time. Sporadically, an increased tumor recurrence rate could be seen if lipofilling was performed shortly after breast cancer surgery.

Lipofilling in breast cancer patients should be carried out 24 to 36 months after complete recovery at the earliest!

Experts are also discussing an increased cancer risk through autologous fat tissue transplantation: Mesenchymal stem cells are found in the fatty tissue. They enable fatty tissue to regenerate by forming new fat cells. Since stem cells generally can separate and differentiate into other cells, the risk that they may also turn into cancer cells exists. Up to now, there is no evidence of an increased tumor risk from the mesenchymal stem cells contained in the fat transplant.

How Much Does It Cost?

Depending on the clinic, the prices for a breast enlargement range between 4,500 and 6,500 euros. For a wrinkle treatment with lipofilling, you have to pay about 2.500 Euro.

Which Doctors and Clinics are Specialized in Lipofilling?

Usually, a specialist for plastic and aesthetic surgery carried out lipofilling. There are numerous clinics and practices in Germany specializing in plastic and aesthetic surgery; many offer lipofilling. Specialized dermatologists can also carry out the autologous fat injection of wrinkles in the face. The success of the treatment depends mainly on the method used and the experience of the clinic! Therefore, the patient should get informed well before the surgery and choose the doctor or clinic carefully.

Sources:

Leitlinie „Autologe Fetttransplantation“, erstellt 2015 als Leitlinie der Deutschen Gesellshaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgie

„Stellenwert der autologen Fetttransplantation in der Brustheilkunde“; D.Rezek; Ästhetische Chirurgie, 2015

„Zellassistierte Eigenfetttransplantation“; Grabin S., Antes G., Stark GB., Motschall E.,Buroh S., Lampert FM.; Deutsches Ärzteblatt 2015

„Autologe Fetttransplantation in die weibliche Brust-Klinische Anwendung und Sicherheitsaspekte“, René D. Largo, Jürg Häcki, Sinan Güven, Arnaud Scherberich, Alexandre Kämpfen, Daniel F. Kalbermatten, Martin D. Haug, Dirk J. Schaefer; Schweizer Medizinforum 2011

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