Dedifferentiated fat cells (DFATs), which are originated by the dedifferentiation of adipocytes, display surface markers of mesenchymal stem cells and are able to differentiate into different cell ...types, thus, yielding a huge therapeutic potential in repairing damaged tissues and organs. The use of allogeneic stem cells from healthy donors constitutes the basis of a new strategy for cell therapy in the field of transplantation and the first requirement for allografts is determining their immunological properties. In this study, human DFATs and ADSCs were passaged as in vitro models to investigate their immunomodulatory effects. Phenotypic analysis of cell surface markers and three-line differentiation protocols were used to identify stem cells. The immunogenic phenotypes of DFATs and ADSCs were analyzed by flow cytometry and a mixed lymphocyte reaction was used to assess their immune function. The characteristics of stem cells were confirmed by phenotypic identification of cell surface markers and three-line differentiation. Flow cytometry analysis showed that P3 generation DFATs and ADSCs contained human leukocyte antigen (HLA) class I molecules, but did not express HLA class II molecules and costimulatory molecules CD40, CD80 and CD86. Moreover, allogeneic DFATs and ADSCs could not induce the proliferation of peripheral blood mononuclear cells (PBMCs). In addition, both populations were shown to inhibit the Concanavalin A-stimulated proliferation of PBMCs and act as third-party cells responsible for inhibiting the mixed lymphocyte response. DFATs have immunosuppressive properties similar to ADSCs. Based on this, allogeneic DFATs have potential applications in tissue repair or cell therapy.
Objective
This study reviewed the literature regarding different fat processing techniques, in order to update the information for healthcare personnel and provide the latest evidence in selecting ...purification methods.
Methods
PubMed (MEDLINE), EMBASE, the Cochrane Library, and the Cochrane Central Register of Controlled Trials were comprehensively searched to identify studies that compared different fat purification methods for animal and human studies published through July 2020. Papers were screened using inclusion and exclusion criteria, and relative data were collected for review.
Results
A total of 3292 studies were identified, of which 30 were included for review. The findings of existing clinical studies showed that the filtration and washing filtration methods performed better in the volume retention rate of adipose tissue. In terms of postoperative complications (fat necrosis, nodules, cysts, etc.), the incidence of complications of centrifugation is generally higher than that of other purification methods, while Telfa gauze and washing filtration system show better safety. More comparative studies are needed to draw conclusions about clinical efficacy and satisfaction. The existing basic science studies generally believe that centrifugation has no advantage in the integrity and metabolic activity of adipose tissue. However, there is no definite conclusion about the volume retention rate of grafts in animal experiments.
Conclusion
In recent years, studies on the cost-effectiveness of various purification methods have emerged, and the efficiency advantages of commercial systems have also been gradually reflected. In the future, the purification efficiency will be improved based on ensuring clinical efficacy, which will be translated into cost savings.
Level of evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
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.
Background
Autologous fat grafting has been widely used in the field of plastic surgery, especially breast aesthetic augmentation. However, postoperative fat volume retention rate is still difficult ...to predict.
Objective
The authors conducted a retrospective study to compare the fat volume retention rate in patients with varying lactation histories.
Methods
A retrospective study was performed of patients who underwent autologous fat grafting breast augmentation in our center from 2012 to 2018. Individuals were separated into two groups according to their lactation history: Group A without a history of lactation and Group B with a history of lactation.
Results
A total of 70 cases (137 breasts) were included (Group A,
n
= 40; Group B,
n
= 30). Patients without lactation history were younger (Group A, 25.88 years; Group B, 36.03 years,
p
< 0.05) and had a significantly lower mean body mass index (Group A,19.72 kg/m
2
; Group B, 20.83 kg/m
2
,
p
= 0.010). The proportion of donor sites varied (Group A, abdomen 25%, thigh 70%; Group B, abdomen 53.33%, thigh 46.67%,
p
< 0.05). The percentage of tissue volume retained of patients with a history of lactation was significantly higher (Group A, 30.42%; Group B, 41.03%,
p
= 0.028).
Conclusion
Significant differences in postoperative volume retention rate in different patients based on lactation history were observed. The volume retention rate after breast augmentation with autologous fat is higher in patients with a history of lactation. The physiological process of lactation may influence the response to autologous fat grafting, but further studies of the mechanism are needed.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
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.
Background
Gynecomastia is a common condition that refers to the benign enlargement of male breasts. Several minimally invasive techniques were invented to avoid visible scars in the chest area, but ...have limited effects on the dense fibroglandular breast tissue, and open excision remains the mainstay of treatment. Endoscopic subcutaneous mastectomy has the superiority of visualization, facilitating accurate dissection and hemostasis, also enabling inconspicuous scars. This study was designed to evaluate the patient-reported outcomes of the endoscopic axillary approach in treating gynecomastia, to interpret the differences between it and the conventional periareolar open excision method, and to present our experience utilizing this technique as a reliable alternative for Simon I and II gynecomastia.
Methods
Eighty-three participants diagnosed with Simon I or II gynecomastia were included in this cross-sectional study, among which 31 were preoperative and 52 were postoperative patients. Postoperative participants were divided into two groups according to whether endoscopic axillary subcutaneous mastectomy (axillary group,
n
= 25) or periareolar open excision (periareolar group,
n
= 27) was performed. Patient-reported outcomes were assessed using the BODY-Q questionnaire, including the chest, nipples, body image, social, appearance-related distress, and scar domain, with scores ranging from 0 to 100.
Results
The BODY-Q score of both axillary and periareolar postoperative groups showed significant improvement on chest (
p
< 0.001), nipples (
p
< 0.001), body image (
p
< 0.001), and appearance-related distress (
p
< 0.005) scales, compared with the preoperative group. Of the scar scale, the axillary group rated higher scores than the periareolar group (
p
= 0.019), analysis of the individual scale items showed more positive responses in questions “Location of your scars?” (
p
< 0.001) and “How your scars look when they are not covered by clothes?” (
p
< 0.001), the item “Having to dress in a way to hide your scars?” also had a somewhat more positive responses from participants (
p
= 0.095).
Conclusions
The present findings indicate that compared with the periareolar excision, patients who underwent gynecomastia subcutaneous mastectomy through endoscopic axillary approach have higher scar satisfaction with postoperative outcomes, this probably because of the well-hidden scar at the axilla, which leverages the psychologic burden of the patient after surgery. Future prospective studies are needed to measure changes over the entire patient journey, to find out the predictable factors of postoperative patient satisfaction, and determine how the objective outcomes relate to changes in patient’s health-related quality of life.
Level of Evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors
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.
Background
Intraoperative symmetrical assessment plays a decisive role in the aesthetic results of reduction mammaplasty, but it depends mostly on the surgeons’ experience that may be biased by ...individual subjective factors. This study was intended to propose an objective method based on a hand-held three-dimensional (3D) scanner to assist intraoperative symmetrical assessment, aiming to achieve better aesthetic results in reduction mammaplasty.
Methods
Sixty patients were enrolled in the study from April 2018 to January 2020. Intraoperative 3D scanning was routinely performed on 29 patients (study group) to assist symmetrical adjustments during breast shaping. 3D surface scanning data of both groups were obtained at 3 months postoperatively to objectively assess breast symmetry. Postoperative symmetry scores in five aspects, including nipple-areolar complex position, inframammary-fold height, breast size, shape, and footprint, were rated by six independent observers based on anonymized photographs to subjectively evaluate pre- and postoperative breast symmetry of the two groups.
Results
The bilateral breast volume difference of the study group was significantly smaller than the control group (39.1 vs. 113.3 cm
3
,
p
= 0.001), as well as the difference in nipple to inframammary-fold distance (2.79 vs. 7.43 mm,
p
= 0.01). The observer-reported results showed that breast reduction significantly improved postoperative symmetry in all five aspects compared with preoperative symmetry in the study group (
P
<0.001). Furthermore, postoperative symmetrical ratings of all five aspects in the study group were statistically better than the control group (
P
<0.05).
Conclusions
Intraoperative 3D scanning provided a reliable method to assist symmetry adjustments and ensure better postoperative breast symmetry in reduction mammaplasty.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
.
Background
The goal of breast plastic surgery is to improve the shape of the breasts. The shape of the breast is determined by several parameters and proportions; however, the proportions that have ...the greatest impact on breast aesthetics have not been investigated. The purpose of this study is to determine which breast proportions are crucial to aesthetics and should be given priority when surgery is designed.
Methods
Breasts were divided into a high-satisfaction group and a low-satisfaction group according to an aesthetic evaluation that consisted of self-evaluations and evaluations by plastic surgeons. Three-dimensional scanning and measurement of the breasts were performed. The differences in breast parameters and proportions between the two groups were analyzed, and the ROC curve of each proportion was applied to determine which index had a significant influence on satisfaction and could predict satisfaction well.
Results
A total of 179 unilateral breasts were evaluated and measured; of these, 68 breasts were classified as high satisfaction, and 111 were classified as low satisfaction. There were no significant differences in breast width between the two groups. In the high-satisfaction group, the absolute value and the value divided by the breast width of breast projection and the lower pole length were significantly greater than those of the low-satisfaction group. The areas under the ROC for breast projection and lower pole length, as aesthetic predictive indexes, were greater than 0.7.
Conclusions
Breast width emerged as the benchmark of breast aesthetic assessment. Breast projection and the lower pole length had a great impact on unilateral breast aesthetics and should be given priority when improving the breast shape, and appropriate ratio of low pole length and breast projection to breast radius might bring a more satisfying outcome.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
.
