Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China.
Aesthetic Plast Surg. 2022 Oct;46(5):2488-2499. doi: 10.1007/s00266-021-02604-w. Epub 2021 Oct 1.
Postoperative fat volume retention rate (PFVRR) after augmentation mammoplasty with autologous fat grafting is highly variable on an individual basis and challenging to be predicted. However, at present, there is a lack of further research on the relevant preoperative patient's self-related influencing factors. The early inflammatory response degree, directly influenced by preoperative inflammatory level, is an indispensable part of angiogenesis, which is a key factor in adipocyte survival.
A retrospective review was conducted of patients who underwent breast augmentation with autologous fat grafting performed by a senior surgeon. Preoperative patient demographics and laboratory findings relevant to inflammatory level, such as monocyte to lymphocyte ratio (MLR), were included as the independent variables. The PFVRR more than 3 months after the operation was included as the dependent variable. Key factors influencing the PFVRR were analyzed.
Sixty-three patients were included. The total volume of bilateral fat injection was 375.00 (range, 320.00-400.00) mL, and the long-term bilateral volumetric change was 106.98 (range, 69.90-181.58) mL. The mean PFVRR was 35.36% ± 15.87%, and the preoperative MLR was an independent positive influencing factor of it, while the lymphocyte (L) count was negative. By ROC curve analysis, a value of MLR equal to 0.23 was the diagnostic cut-off point for whether PFVRR was greater than 50%, and its area under the curve was 0.870, with a sensitivity of 93.33% and a specificity of 81.25%. The other hematological parameters and demographics such as age, body mass index, and donor site were not significantly correlated with the PFVRR.
Preoperative peripheral blood inflammatory indicators can influence the PFVRR, with the MLR positively and L count negatively. Based on the diagnostic threshold of MLR = 0.23 derived from this study, clinicians can make reasonable predictions of whether half of the injected fat volume would be retained based on preoperative blood routine tests that are readily available.
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自体脂肪移植隆乳术后的脂肪体积保留率（PFVRR）个体差异很大，难以预测。然而，目前对于相关术前患者自身相关影响因素的研究还不够深入。早期炎症反应程度直接受术前炎症水平的影响，是血管生成的一个不可或缺的部分，而血管生成是脂肪细胞存活的关键因素。
对一位资深外科医生进行的自体脂肪移植隆乳术患者进行了回顾性分析。将术前与炎症水平相关的患者人口统计学和实验室检查结果（如单核细胞与淋巴细胞比值（MLR））纳入自变量。术后 3 个月以上的 PFVRR 为因变量。分析影响 PFVRR 的关键因素。
共纳入 63 例患者。双侧脂肪注射总量为 375.00（范围 320.00-400.00）mL，长期双侧体积变化为 106.98（范围 69.90-181.58）mL。平均 PFVRR 为 35.36%±15.87%，术前 MLR 是其独立的正影响因素，而淋巴细胞（L）计数为负影响因素。通过 ROC 曲线分析，MLR 等于 0.23 为预测 PFVRR 是否大于 50%的诊断界值，曲线下面积为 0.870，敏感度为 93.33%，特异度为 81.25%。其他血液学参数和人口统计学参数如年龄、体重指数和供区与 PFVRR 无显著相关性。
术前外周血炎症指标可影响 PFVRR，MLR 呈正相关，L 计数呈负相关。基于本研究得出的 MLR=0.23 诊断界值，临床医生可根据术前血常规检查结果，对半数注入脂肪量是否能保留做出合理预测。
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