Munhoz Alexandre Mendonça, Maximiliano João, Neto Ary de Azevedo Marques, Duarte Daniele Walter, de Oliveira Antonio Carlos Pinto, Portinho Ciro Paz, Zanin Eduardo, Collares Marcos Vinicius Martins
From the Plastic Surgery Division, Hospital Sírio-Libanês; Breast Surgery Group, Plastic Surgery Division, University of São Paulo School of Medicine; Hospital Moriah; and Plastic Surgery Division, Hospital de Clínicas de Porto Alegre.
Plast Reconstr Surg. 2022 Oct 1;150(4):782-795. doi: 10.1097/PRS.0000000000009605. Epub 2022 Jul 26.
Autologous fat grafting is a procedure indicated for breast augmentation to improve coverage of silicone implants and redesign breast shape. Different techniques are based on parameters that have not been systematically standardized. The authors present a method using breast zone standardization based on breast anatomy to achieve an anatomical composite breast.
The authors performed this zone standardization in 76 breasts (38 patients) undergoing primary/secondary augmentation. The area between the implant and the clavicle and parasternal area was marked to receive fat grafting and divided into three zones. A mathematical formula [ volume of autologous fat graft = (π × r 2 × p)/4.8] was used to estimate the fat graft volume according to implant volume in the respective zones.
Implant volumes ranged from 205 to 375 cc (mean, 265 cc), and patients received an average fat graft volume of 105.3 cc per breast (range, 36 to 135 cc); the average fat volume in zones I/II and III was 78.28 cc (range, 0 to 100 cc) and 27.03 cc (range, 15 to 60 cc), respectively. Three minor complications were observed (5.2 percent) during a mean follow-up of 12.8 months. A high correlation was observed between the fat grafting performed in the cohort and predictions obtained from the formula ( p < 0.001).
Recognizing risky cleavage breast zones between the implant pocket and the upper and medial quadrants remains essential to attain satisfactory outcomes. Although experience and proper judgment are still important in the fat grafting technique, the data presented here offer plastic surgeons an additional standardized framework to help deliver predictable hybrid breast augmentation. .
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
自体脂肪移植是一种用于隆乳的手术，旨在改善硅胶假体的覆盖并重塑乳房形状。不同的技术基于尚未系统标准化的参数。作者提出了一种基于乳房解剖结构进行乳房区域标准化的方法，以实现解剖学复合乳房。
作者在76例接受初次/二次隆乳的乳房（38例患者）中进行了这种区域标准化。标记出假体与锁骨之间以及胸骨旁区域以接受脂肪移植，并将其分为三个区域。根据各区域假体体积，使用数学公式[自体脂肪移植体积 = (π × r² × p)/4.8]来估计脂肪移植体积。
假体体积范围为205至375立方厘米（平均265立方厘米），患者每侧乳房平均接受的脂肪移植体积为105.3立方厘米（范围为36至135立方厘米）；I/II区和III区的平均脂肪体积分别为78.28立方厘米（范围为0至100立方厘米）和27.03立方厘米（范围为15至60立方厘米）。在平均12.8个月的随访期间观察到3例轻微并发症（5.2%）。在该队列中进行的脂肪移植与公式预测结果之间观察到高度相关性（p < 0.001）。
认识到假体腔隙与上内侧象限之间有风险的乳房间隙对于获得满意结果仍然至关重要。尽管在脂肪移植技术中经验和正确判断仍然很重要，但此处提供的数据为整形外科医生提供了一个额外的标准化框架，以帮助实现可预测的混合隆乳。
临床问题/证据水平：治疗性，IV级。
