Breast enhancement by means of an adipose and stromal cell suspension: Adipofilling®

Q) What is the difference between Adipofilling and lipofilling?
A) It’s a question of size. Adipofilling is cellular, while lipofilling is lobular. A cell suspension can be injected immediately beneath the dermis, and even into the dermis; by contrast, the superficial injection of lobular fat can cause problems. With Adipofilling, the stem cells are distributed uniformly in the tissues, while with lipofilling the stem cells remain within the structure of the adipose lobule. With Adipofilling, the suspension to be injected can easily be enriched with stem cells, which makes for greater efficacy in terms of both volume enhancement and regeneration. With Adipofilling, the adipose material is drawn through a 4 mm or 3 mm cannula; lipofilling uses finer cannulas, which, in addition to slowing down the process of extracting the fat, cause considerable damage to the lipo-aspirate.

Q) If the cell suspension is centrifuged at 400 rpm for 4 minutes, the stromal cells are isolated; what happens if these cells are not remixed with the adipocytes?
A) The stromal cells, which contain the stem cells, play an important role in the survival and rooting of the cell graft. Grafting only adipose cells does not yield the same results.

Q) Here, we can see signs of a physical action around the navel…
A) Another operator burned this patient with an apparatus called “plasma scintillator” or “electron-flow scintillator”. My mother, Dr. Spolidoro, used similar equipment over 70 years ago! As I’ve already said, it’s very unlikely that a physical means can equal, let alone improve upon, the biological action of Adipofilling, the results of which increase exponentially as sessions are repeated. The result seen in this video publication was achieved in only one session of Adipofilling!

Q) Can facial atrophy (PRS) also be treated with Adipofilling?
A) Yes, and the results are very good.

Q) What other pathologies have been treated with Adipofilling?
A) We have treated cases of radio-dermatitis, even with exposure of the bone; in elderly patients, we have prepared the scalp for the trouble-free creation of the skin flaps needed for reconstruction following destruction by cancer; we have injected Adipofilling immediately beneath the scars left by extensive burns; we have used it in the rectum, labia majora and vagina, in the lips of patients with scleroderma, in the sequelae of poliomyelitis, in scoliosis, etc.

Q) What are the most common aesthetic applications?
A) Volumetric enhancement of the lips and of the face in general, including the forehead; in the hands; in the breasts, sometimes after breast coning by means of the elastic thread (Elasticum® Korpo, Genova, Italy); in all forms of subcutaneous and muscular tissue loss; beneath stretch marks, owing to its potent biological action; in the nasal pyramid, where it eliminates the appearance of the “remodeled nose”; on the face and body in general, including the scalp.

Q) Is Adipofilling performed by means of a disposable instrument?
A) The instrument is extremely economical. Moreover, using a disposable instrument ensures proper preparation of the lipoaspirate, sterility and the absence of cross-contamination.

Q) Does performing Lipostructure still make sense?
A) To be honest, in my opinion, it has never made sense.

Q) Does Adipofilling® survive better than adipose tissue grafted by other techniques because it is a cell suspension?
A) Yes, individual cells display better survival and are much easier to nourish than a lobule. Fragmentation of the adipose lobules is much less damaging than centrifugation at 3000 rpm, which is complete madness.

Q) Why?
A) First of all, saying 3000 rpm for three minutes is unclear. Let’s talk about atmospheres. In any case, we may suppose that 3000 rpm corresponds to about 1500 atm. During this treatment, some of the adipose cells burst (a lot of oil in the supernatant). Although the adipocytes appear to be intact, on electron microscopy they present numerous micro-vacuoles, which does not augur well. By contrast, after mechanical fragmentation, the oily supernatant is minimal and the size of the adipocyte (100,000 nm) protects it from damage. Anyone familiar with granulometry knows this.

Q) Is Adipofilling® of the breast an ambulatory procedure? How long does it take?
A) Yes, Adipofilling® is an ambulatory procedure. The process of transforming the lobular fat into a cell suspension by means of the Adipopimer® takes a few seconds; washing the lipo-aspirate takes longer.

Q) Why do you need to wash it?
A) Washing removes the anaesthetic, the epinephrine and the blood, if present, in the lipo-aspirate. To reduce washing time, we can prepare an anaesthetic solution with 1 mg of epinephrine in 500 ml of lactate Ringer, and wait 10 minutes after infiltration; this limits the amount of blood in the lipo-aspirate, thereby accelerating washing. The presence of blood requires more prolonged washing of the lipo-aspirate.

Q) To make up the anaesthetic solution, do you have to use carbocaine?
A) Studies conducted by diabetologists have shown that lidocaine hinders the entry of glucose into the adipose cell. However, we have not observed any substantial clinical difference after thorough washing, and we now use lidocaine, which is more economical.

Q) What degree of volume increase can be achieved?
A) The increase in volume may be considerable, but this depends on the quantity of the patient’s adipose tissue and, naturally, on the number of procedures carried out. If the patient has little excess adipose tissue, the volume increase will be modest; in such cases, we can correct asymmetry and the form of the breasts, for example by widening the base of the breasts or filling them where volume is lacking.

Q) Is it possible to enrich the cell suspension with stem cells?
A) Yes, it’s easy to enrich the cell suspension with stem cells. All you need to do is centrifuge a portion of the Adipofilling® cell suspension at the slowest speed of the centrifuge for four minutes. Centrifugation causes a thin white layer to collect in the distal portion of the syringe; this layer is made up of stromal cells, and it is this layer that contains the stem cells.

Q) Once the stem cells have been isolated, what needs to be done?
A) The layer that has settled at the bottom of the syringe has to be mixed with the non-centrifuged cell suspension by means of two syringes and a connecting tube. The stromal cells obtained by centrifugation at the minimum centrifuge speed are utilized, together with the adipocytes, for small corrections, e.g. of the nose.

Q) Are stem cells frequently added to the suspension?
A) We have never added stem cells during breast procedures; we do not think that the mammary tissue should be stimulated excessively.

Q) How is the lipo-aspirated lobular fat washed?
A) An Erlenmeyer flask equipped with a tap is used and the lobules are washed until the Ringer solution becomes colourless.

Q) What are the secrets of this procedure?
A) Drawing off the fat through a large-diameter cannula at low aspiration pressure, washing it thoroughly, fragmenting it properly with the Adipopimer®, and distributing it carefully in the subcutaneous tissue. The Adipopimer® is to be used only once; in this way, ideal fragmentation is always achieved.

Q) Why should the fat be drawn through a large-calibre cannula?
A) A large cannula damages the adipose cells less than a small cannula.

Korpo thanks Medical Video Journal CRPUB.ORG open access for the material placed at our disposal.