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LETTERS

Fat Grafting to the Breast Revisited: Safety and Efficacy

Colwell, Amy S. M.D.; Borud, Loren J. M.D.

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Plastic and Reconstructive Surgery: January 2008 - Volume 121 - Issue 1 - p 340-341
doi: 10.1097/01.prs.0000294958.33515.08
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Sir:

We read with great interest the article entitled “Fat Grafting to the Breast Revisited: Safety and Efficacy” by Drs. Coleman and Saboeiro in the March 2007 issue of the Journal. The authors describe their technique for autologous fat grafting to breasts to correct micromastia or deformity resulting from augmentation, reconstruction, tuberous breasts, or Poland’s syndrome. They should be congratulated for their excellent long-term results utilizing this technique.

We had the opportunity to hear the authors present this paper at the Annual Meeting of the American Society for Aesthetic Plastic Surgery, in New York. During the discussion of harvest and refinement, a member of the audience raised the question of sterility. Specifically, there was concern about placing a sterile syringe filled with lipoaspirate and capped only on one side into an unsterilized centrifuge machine. Dr. Coleman turned the question back to the audience to see whether anyone could improve on the sterility aspect of the procedure by possibly finding a way to sterilize the centrifuge machine. There was no response.

From our experience in cell culture techniques, we know that sterilization of the centrifuge is not necessary to sustain cells in culture without contamination for very long periods of time.1 The key to success is to maintain a closed sterile environment inside the centrifuge. We perform our fat harvesting using a technique similar to that described by Coleman, with the following exception: we place a sterile piece of transparent film (Tegaderm; 3M, St. Paul, Minn.) over the open end of the syringe after the plunger has been removed (Fig. 1). This cheap, simple modification prevents potential dust or debris from the centrifuge lid from contaminating the fat. Importantly, the closed sterile environment is maintained inside the nonsterile centrifuge. Utilizing this technique, we have had no infectious complications from our injections.

Fig. 1.
Fig. 1.:
Fat grafting technique to optimize sterility. In preparation for fat harvest, sterile syringes with sterile caps and sterile transparent film are obtained (above). Lipoaspirate is transferred into the syringe and the cap is placed on one end. To seal the syringe and thus the sterile environment, transparent film is placed over the open end (below). Syringes are then transferred into sterilized centrifuge containers that have been placed inside the centrifuge machine.

Amy S. Colwell, M.D.

Loren J. Borud, M.D.

Harvard Medical School

Beth Israel Deaconess Medical Center

Boston, Mass.

REFERENCE

1. Colwell, A. S., Phan, T. T., Kong, W., et al. Hypertrophic scar fibroblasts have increased CTGF expression after TGF-beta stimulation. Plast. Reconstr. Surg. 116: 1387, 2005.

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