2 research outputs found
Volume Retention, Metabolism, and Cellular Composition of Human Fat Xenografts
Background:. To optimize the take of transferred fat, better understanding of fat graft morphology and growth properties in vivo is critical. We aim to evaluate survival, volume retention, metabolism, and cellular composition of various aliquots of human fat xenografts.
Methods:. Twenty athymic nude mice were injected subcutaneously in opposing flanks with 0.1βml (small) and 1.0βml (large) aliquots of human fat graft. Volume (ultrasound) of fat aliquots was measured at baseline, 1, 3, and 12 weeks after implantation. Tissue metabolism (18F-FDG), Hematoxylin and Eosin, special stains, and immunohistochemical analysis were performed at 3 and 12 weeks to determine graft viability, cell origin, and proliferative activity.
Results:. Only 1 of 10 small grafts were detected after 12 weeks by ultrasound and 5 of 10 were found at necropsy. Volume of large grafts decreased significantly from baseline at 3 (827βΒ±β195βmm3 versus 953βΒ±β122βmm3; P = 0.004) and 12 weeks (515βΒ±β163βmm3 versus 953βΒ±β122βmm3; P = 0.0001). Metabolism increased with time in small (0.6βΒ±β0.4%ID/g versus 2.0βΒ±β1.1%ID/g, P = 0.01) and large grafts (0.4βΒ±β0.3%ID/g versus 1.4βΒ±β0.9 %ID/g; P = 0.005). Large grafts viability decreased between 3 and 12 weeks (72βΒ±β20% versus 31βΒ±β30%; P = 0.012) although small graft viability remained unchanged. Viable and proliferating human and mouse adipocytes and chimeric blood vessels were seen within grafts at both time points.
Conclusions:. Larger graft aliquot was associated with better volume retention by ultrasound but lower viability by histology. Graft metabolism increased with time irrespective of aliquot size potentially due to regenerative processes of both donor and recipient origin
Subcutaneous Prosthetic Breast Reconstructions following Skin Reduction Mastectomy
Background:. Prepectoral prosthetic breast reconstruction is gaining popularity, offering muscle preservation and outcomes similar to subpectoral implant placement in small or moderate size breasts. This study compares the complications of prepectoral and subpectoral immediate prosthetic breast reconstructions following skin reduction mastectomy in large and ptotic breasts.
Methods:. All consecutive patients who underwent immediate tissue expander-based reconstruction following Wise pattern skin reduction mastectomy from November 2011 through August 2017 by a single surgeon were reviewed. The collected data included patient demographics and complications (eg, skin necrosis, hematoma, infection, seroma, implant loss, capsular contracture).
Results:. A total of 54 patients underwent 87 immediate breast reconstructions including 45 subpectoral and 42 prepectoral tissue expander placements. The subpectoral patients had greater body mass indexes (32.5βΒ±β6.6 versus 29.9βΒ±β5.4, P = 0.026), higher initial (518βΒ±β168βml versus 288βΒ±β140βml, P < 0.001) and final (694βΒ±β123βml versus 585βΒ±β122βml, P = 0.014) implant volumes, more skin flap necrosis (40.0% versus 16.7%, P = 0.044) and infections (37.8% versus 11.9%, P = 0.01) than their prepectoral counterparts, whereas seromas were more common in the prepectoral group (4.4% versus 26.2%, P = 0.015). The overall complication rate, although higher in the subpectoral group compared with the prepectoral group, was not significantly different (62.2% versus 40.5%, P = 0.072).
Conclusions:. Prepectoral tissue expander placement after skin reduction mastectomy is an appealing reconstructive option in patients with large and ptotic breasts. Prosthetic reconstruction following Wise-pattern skin reduction mastectomy is invariably associated with high complication rates irrespective of the plane of implant placement. Greater emphasis should be placed on patient counseling and complication prevention in this challenging patient population