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Comparative Analysis of Processing Methods in Fat Grafting

Salinas, Harry M. M.D.; Broelsch, G. Felix M.D.; Fernandes, Justin R. M.D.; McCormack, Michael C. M.B.A.; Meppelink, Amanda M. B.S.; Randolph, Mark A. M.A.S.; Colwell, Amy S. M.D.; Austen, William G. Jr. M.D.

Plastic and Reconstructive Surgery: October 2014 - Volume 134 - Issue 4 - p 675–683
doi: 10.1097/PRS.0000000000000524
Experimental: Original Articles
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Background: Centrifugation is a popular processing method, with an unclear mechanism of action. Hypotheses include fat concentration, reduced inflammatory response by removal of blood, and concentration of adipose-derived stem cells. The authors performed multiple experiments to determine the role of centrifugation and compared it with a different processing method (mesh/gauze technique).

Methods: Lipoaspirate components were quantified after centrifugation at increasing speed to determine concentration efficacy. For comparison, the authors quantified the concentration efficacy of mesh/gauze. They also compared the number of adipose-derived stem cells isolated by either method. To determine the effects of each component, they compared fat alone to fat mixed with various spinoff components in a mouse model. They also compared centrifugation to mesh/gauze.

Results: The adipocyte fraction remains constant above 5000 g, whereas 1200 g results in 91 percent concentrated fat. Mesh/gauze also results in 90 percent concentrated fat. The number of adipose-derived stem cells in 1 g of fat was 1603 ± 2020 and 1857 ± 1832 in the centrifuge and mesh/gauze groups, respectively (p = 0.86). Five “add-back” groups were created: fat plus oil, fat plus surgical tumescence, fat plus fresh tumescence, fat plus cell pellets and fresh tumescence, and fat plus cell pellets. The fat-only group had better retention than the groups mixed with tumescence, regardless of whether it was surgical, fresh, or had cell pellets. Oil did not affect grafts. Centrifugation at 1200 g was equivalent to mesh/gauze (0.73 ± 0.12 g and 0.72 ± 0.13 g, respectively).

Conclusions: Centrifugation improves graft retention by concentration of the adipocyte fraction. The concentration efficacy of mesh/gauze is equivalent to centrifugation at 1200 g, with equivalent in vivo outcomes.

Boston, Mass.

From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital.

Received for publication November 11, 2013; accepted February 10, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

William G. Austen, Jr., M.D., Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC 435, Boston, Mass. 02114, wausten@partners.org

©2014American Society of Plastic Surgeons