Methods used for evaluation of volume retention rate in autologous fat grafting for breast augmentation: a systematic review.

BACKGROUND: Autologous fat grafting has gained popularity in breast augmentation. Various methods can be used to estimate the volume retention rate. This systematic review aimed to establish whether the type of method used for measuring breast volume is a factor that influences the reported volume retention rate. METHODS: Studies were identified using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception of the database up to February 2019. Articles describing autologous fat grafting for breast augmentation were selected based on pre-determined inclusion and exclusion criteria. The characteristics of the included studies were summarized, and the reported volume retention rate from the studies was compared. A quality assessment of all included articles was performed using the methodological index for non-randomized studies criteria. RESULTS: A total of 618 articles were identified, of which 12 studies, with a total of 1337 cases, were eligible. The retention rate of injected adipose tissue varied when the method of fat grafting and volume analysis used were both the same, as well as when the method of fat grafting was the same but the method of volumetric evaluation used was different. CONCLUSIONS: Currently, the tools available for estimating the volume retention rate come with limitations. In order to objectively evaluate the percentage of graft retention, a standard protocol that applies to the different methods should be established in the future.

Functional annotation of the microRNA-mediated network in gigantomastia by integrating microRNA and mRNA expression profiling.

BACKGROUND: Gigantomastia is the overdevelopment of the female mammary gland, and it causes great physiological and psychological burdens to patients. A better understanding of the molecular mechanisms involved in gigantomastia is needed to develop less invasive and more effective medical treatments. MicroRNA (miRNA) is a class of small noncoding RNAs that play an important regulatory role at the post-transcriptional level. These miRNAs are known to be involved in many diseases, including breast cancer; however, the relationship between miRNA and gigantomastia is largely unknown. METHODS: Whole genome-wide expression of miRNA and mRNA in gigantomastia was detected using microarray and functional annotation was performed based on the altered expression of miRNAs and mRNAs. RESULTS: We found many miRNAs and mRNAs to be significantly differentially expressed in gigantomastia compared with normal breast tissues. Functional annotation analysis indicated that APK, Wnt, and Neurotrophin signaling pathways may participate in gigantomastia. CONCLUSION: This study addresses the need for better diagnosis and treatment of gigantomastia by providing new insight into the molecular mechanisms underlying this disease.

[Digital evaluation of breast symmetry with 3D scanning technique].

OBJECTIVE: To establish a standard method for digital evaluation of breast symmetry with 3D scanning technique. METHODS: From January 2009 to July 2010, 167 patients received 3D scanning before breast augmentation. The coordinate system was established and the 3D reconstructed breast models were analyzed by software. The discrepancy of nipple level, the distance between nipple to midline, inferior mammary fold location, breast width, breast projection, breast volume and anterior chest wall projection were measured. RESULTS: The mean discrepancy of nipple level, the distance between nipple to midline, IMF level, breast width, breast projection and anterior chest wall projection were (4. 8 +/- 3.9) mm, (4.5 +/- 3.4) mm, (4.6 +/- 3.7) mm, (4.8 +/- 2.9) mm, (5.4 +/- 3.9) mm and (4.8 +/- 3.3) mm, respectively. The mean difference of breast volume was (51 +/- 44) ml. The incidence of significant asymmetry was 73% (122/167)in nipple position, 95% (159/167)in breast shape, 38% (63/167)in anterior chest wall projection. CONCLUSIONS: 3D scanning technique can provide an accurate 3D measurement of breast. A thorough and objective evaluation of breast symmetry can be achieved.

[Application of MDCT angiography for breast reconstruction with deep inferior epigastric artery perforator flaps].

OBJECTIVE: To investigate the significance of preoperative MDCT angiography for breast reconstruction with abdominal flap. METHODS: Preoperative MDCT angiography scans were performed on 34 patients who underwent breast reconstruction with abdominal flaps during December 2006 to June 2009. The operation was designed based on the MDCT results. Then the MDCT results were proved intraoperatively. Another 22 cases who underwent breast reconstruction with abdominal flap without preoperative MDCT were selected as controls. The rate of operative method change, the operation time and the flap necrosis were compared between the two groups. RESULTS: The preoperative design changed in 23.53% of the patients, based on the MDCT results. No one had any method change intraoperatively in the group with MDCT. The operative method was changed intraoperatively in 13.64% of the patients in the control group. The mean time spending on flap harvesting was (2.51 +/- 0.64) h in the experimental group and (4.42 +/- 0.21) h in the controlled group (P < 0.05). The rate of complication was 6.12% in the experimental group and 12.5% in the control group (P = 0.017). CONCLUSIONS: Preoperative MDCT angiography is an easy and reliable method for breast reconstruction with abdominal flap. The preoperative design can be more reasonable. It helps to save the operation time and reduce the risk.

Breast augmentation by autologous fat injection grafting: management and clinical analysis of complications.

Autologous fat is an excellent soft-tissue filler, given its abundance and ease of harvest. Nevertheless, the technique is accompanied by postoperative complications such as fat necrosis, calcification, and sclerotic nodules. These problems directly influence surgical efficacy. Computed tomography or magnetic resonance imaging was used to confirm the location of abnormal adipose tissue preoperatively. Depending on the characteristics of the lesion, the liquefied fat was aspirated or the sclerotic lesion excised. Pressurized dressings were used postoperatively for both techniques. Seventeen patients who experienced complications after autologous fat injection were treated. Pathologic examination of excised samples demonstrated changes including fat necrosis, calcification, hyalinization, and fibroplasia. Intramammary autologous fat injection should only be used with caution. Selecting suitable indications and correct surgical techniques make autologous fat grafting an ideal method for breast augmentation. Strictly controlling the injection volume and injecting diffusely in multiple layers to allow fat granules to distribute evenly within the breast, are effective methods to reduce postoperative complications.

[Nipple-areolar reconstruction with the modified arrow flap].

OBJECTIVE: To introduce the clinical experience of nipple-areolar reconstruction with the modified arrow flap. METHODS: The arrow flaps were modified for nipple-areolar reconstruction in 12 cases. Among them, 2 cases were treated with combined thin split-thickness skin graft; 4 cases with autologous rib implant and tattoo; 6 cases with tattoo. RESULTS: All the reconstructed nipples were survived. The reconstructed nipples lost projection 1 month after operation in 2 cases. The other 10 cases retained 50% of the nipple projection 3 months after operation. The results were maintained with satisfactory symmetry during the follow-up period of 6 months to one year. CONCLUSIONS: The modified flap is easily performed with reasonable design and no need of donor site. The nipple projection can be maintained with good long-term effect.