Department of Science and Technology Innovation, 325870UPO University, Alessandria, Italy.
Department of Translational Medicine, 19050UPO University, Novara, Italy.
Inquiry. 2021 Jan-Dec;58:469580211061030. doi: 10.1177/00469580211061030.
Breast reconstruction has gained from lipofilling the possibility to recover the aesthetic outcome of anatomical profile in a more natural appearance. However, until today, the long-term graft survival remains unpredictable, and sometimes it does not guarantee a well-adequate aesthetic result. In the present work, the morphological changes, occurring in fat mass used for refilling, harvested by the Coleman's procedure or through the washing/fragmenting procedure were analysed. Adipocyte size; immunohistochemistry against CD8, CD31, CD68 and M2-type macrophages and catalase enzyme, were analysed on fat mass cultured for 4 weeks. Our observation reveals an increase of connective tissue around the mass and a high number of immune cells occurrence in fat mass harvested by the Coleman's procedure. Instead, the washing/fragmented procedure would reduce the number of immune cells within the fat mass, increase the size of adipocytes, and cause a wider presence of active vessels profile and greater catalase expression. We hypothesize that the fat mass processed by the Coleman's procedure would remain more reactive due to a higher number of immune and macrophages cells, prone to develop cystic formation, leading to a suboptimal integration in the recipient site. On the other hand, the conditions more prone to realize an optimal integration would occur in the fat mass processed by the washing/fragmenting procedure: a reduced number of immune cells, low amount of connective tissue, presence of larger adipocytes. Follow-up monitoring did support our conclusion, as we observed a reduction of re-intervention for refilling procedure in patients treated with the washing/fragmenting procedure.
脂肪填充为乳房重建提供了可能，使其在外观上更接近解剖学特征，从而恢复其美学效果。然而，到目前为止，移植物的长期存活率仍然难以预测，有时并不能保证达到理想的美学效果。在本研究中，我们分析了通过科尔曼（Coleman）技术或洗涤/粉碎技术获取的用于填充的脂肪组织在形态上的变化。我们分析了培养 4 周后的脂肪组织中脂肪细胞大小、针对 CD8、CD31、CD68 和 M2 型巨噬细胞以及过氧化氢酶的免疫组化染色。我们的观察结果显示，通过科尔曼技术获取的脂肪组织周围有更多的结缔组织，且有大量免疫细胞存在；而洗涤/粉碎技术则会减少脂肪组织中的免疫细胞数量，增加脂肪细胞的大小，并导致更广泛的活性血管形成和更高的过氧化氢酶表达。我们假设，通过科尔曼技术处理的脂肪组织由于存在更多的免疫细胞和巨噬细胞，因此会保持更高的反应性，更容易发生囊性形成，导致在受体部位的整合效果不佳。另一方面，通过洗涤/粉碎技术处理的脂肪组织更容易实现最佳的整合：免疫细胞数量减少，结缔组织含量低，存在更大的脂肪细胞。后续的监测结果支持了我们的结论，因为我们观察到接受洗涤/粉碎技术治疗的患者，在进行填充修复手术时，需要再次干预的次数减少。
