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

Q) This patient seems to be very thin. Was it difficult to obtain a sufficient quantity of fat to perform Adipofilling®?
A) Even if the patient is very thin, it is always possible to aspirate 100 mL of fat from one or both trochanters; this will become 60 mL of cell suspension, which is sufficient for these facial corrections.

Q) Which regions is it best to take the fat from?
A) All regions are suitable, but in some the fat needs to be evaluated; for example, the knees are not always suitable because the adipose tissue may be too fibrous.

Q) Does hardening ever occur?
A) After injecting the suspension, we normally massage the area gently to distribute the cells. Some areas may display hardening for a few hours, but the cells nevertheless find their proper location and the tissues become soft again.

Q) Is anesthesia of the receiving area carried out?
A) Only at the entry points of the needle or micro-cannula.

Q) How is the micro-cannula inserted?
A) The skin is pierced with an 18 G needle, and the cannula is inserted through this aperture.

Q) How is the Adipofilling® implanted?
A) As Adipofilling® is a cell suspension, it can be uniformly distributed as if it were a “volumetric revitalization” agent. We avoid multiple insertions of the needle or cannula as this causes needless fibrosis, the effects of which nevertheless disappear in a relatively short time.

Q) Which is the longest phase of this procedure?
A) Washing the lipoaspirate. First of all, I advise using mepivacaine as an anesthetic, because lidocaine prevents glucose from penetrating into the adipose cell. Next, I advise using an efficacious amount of epinephrine and waiting for a sufficiently long time before carrying out liposuction. There should preferably be no blood in the lipoaspirate. These small quantities of fat can be washed with lactate Ringer solution in the same syringe used for aspiration.
Fragmentation with the Adipopimer® (Korpo, Italy) takes only a few seconds.

Q) Is the Adipopimer® that we see the market version?
A) Yes, it is the most recent version, which is the best suited to creating the ideal suspension. Correction of this facial atrophy was achieved with the prototypes that enables us to produce today’s market version.

Q) Can the suspension be frozen?
A) Yes, but we prefer to use it fresh.

Q) Is the result permanent?
A) In the face, the cells present after two months are permanent. Naturally, if the patient puts on weight, the grafted cells will also increase in volume; if the patient loses weight, they will decrease in volume. After Adipofilling® the patient must eat properly without going on a diet.

Q) Is rooting always satisfactory?
A) By performing the technique correctly, we have always obtained good results, without complications. The volume enhancement that we seek to achieve is biological; in other words, it involves living cells. We are not interested in achieving increased volume due to surgical artifacts of traumatic fibrosis or to the insertion of adipose lobules containing apoptotic cells.
The first Adipofilling® procedure may seem disappointing, but it plays an important role in preparing for the subsequent cell graft.

Q) Centrifuged Adipofilling offers the extraordinary possibility of obtaining stromal cells in a few minutes. When are these used?
A) The stromal cells in the fragmented material that is not injected are separated from the adipocytes by means of centrifugation at 300 RPM for about 5 minutes. These cells are remixed with the cell suspension that is to be injected. They are chiefly used for regenerative purposes in several fields, for example in the treatment of radio-dermitis or, by means of intradermal injections, to improve stretch marks on the skin.

Q) Do you realize that Adipofilling and Adipopimer will revolutionize the fat transfer?
A) Sure

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 500 rpm for 5 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) In Adipofilling®, cell survival is better than in other methods of transferring adipose tissue. Is this due to the fact that the filler is a suspension of cells?
A) Yes, individual cells survive better than lobules and are much more easily nourished. Fragmenting the adipose lobules causes far less damage to the cells than centrifugation at 3000 rpm, which is sheer madness.

Q) Why?
A) First of all, it is not clear what is meant by 3000 rpm. We should use the term “atmospheres”. In any case, we can suppose that 3000 rpm corresponds to about 1500 atm. This treatment causes a portion of the adipose cells to burst (a lot of oil is seen in the supernatant). Moreover, on electronic microscopy, the apparently whole adipocytes display numerous micro-vacuoles, which is by no means a good sign. By contrast, after mechanical fragmentation, a minimal amount of oily supernatant is seen and the size of the adipocytes (100,000 nm) safeguards them against damage. Anyone who is familiar with granulometry is well aware of this.

Q) Is Adipofilling® of the breast an ambulatory procedure? How long does it take?
A) Yes. Adipofilling® is an ambulatory procedure. It only takes a few seconds to transform the lobular fat into a cellular suspension with the Adipopimer®; washing the lipoaspirate takes longer.

Q) Why does the lipoaspirate need to be washed?
A) Washing removes any anaesthetic, epinephrine and blood that may be present. To reduce the washing time, an anaesthetic solution of 1 mg of epinephrine in 500 ml of lactate Ringer solution can be prepared; the operator then waits 10 minutes after infiltration. This limits the amount of blood in the lipoaspirate, thereby reducing the washing time; indeed, the presence of blood in the lipoaspirate necessitates more prolonged washing.

Q) To make up the anaesthetic solution is it necessary to use mepivacaine?
A) Studies conducted by diabetologists have shown that lidocaine prevents glucose from entering the adipose cells. However, after thorough washing, we have not observed substantial clinical differences between mepivacaine and lidocaine, however we use mepivacaine.

Q) How much can breast volume be increased by?
A) A considerable increase in breast volume can be achieved, though this depends on the amount of adipose tissue that the patient has and, naturally, on the number of operations performed. If the patient has little superfluous adipose tissue, the volumetric increase will be modest. However, the available adipose tissue can be used to correct any asymmetry and to improve the shape of the breast, for example by widening the base or filling areas where the volume is insufficient.

Q) In Adipofilling®, can the cellular suspension be enriched with stem cells?
A) Yes, quite easily. Stem cells can be isolated by centrifuging a portion of the cellular suspension for five minutes at the lowest speed of the centrifuge. A thin white layer of stromal cells will be seen to form at the distal end of the syringe; these cells contain the stem cells.

Q) Once the stem cells have been isolated, what has to be done?
A) The layer that forms at the end of the syringe has to be mixed with the non-centrifuged cellular suspension; this is done by means of a connecting tube. The stromal cells obtained by means of minimum-velocity centrifugation are used, together with the adipocytes, for small corrections, for example corrections of the nose.

Q) Are stem cells often added?
A) We have never used them in breast procedures. We do not think it is advantageous to stimulate the breast tissue excessively.

Q) How is the washing of the lobular fat lipoaspirate carried out?
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 “tricks of the trade” in this operation?
A) The fat must be drawn off through a large-calibre cannula at a low aspiration pressure; it must then be thoroughly washed, carefully fragmented with the Adipopimer® and uniformly spread in the subcutaneous tissue. The Adipopimer® is used only once; in this way, ideal fragmentation is always obtained.

Q) Why does the fat have to be drawn off through a large-calibre cannula?
A) A large-calibre cannula causes less damage to the adipose cells than a small-calibre cannula

 

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