Advancements in Breast Lipofilling: A 12-Year Retrospective Comparative Analysis of Patient Satisfaction and Complication Rates across Fat Preparation Methods

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BACKGROUND: Breast lipofilling is a commonly utilized method in plastic surgery for breast reconstruction and augmentation. However, the procedure is often limited by the unpredictable survival of fat grafts, leading to dissatisfied patients and associated risks of complications. To address these challenges, recent innovations in fat processing methods, such as the Cell Enriched Lipotransfer (CELT) technique, have been developed to improve both graft retention and overall clinical outcomes. PURPOSE: This study aims to compare patient satisfaction and complication rates associated with different fat preparation techniques- including filtration, sedimentation, and CELT method-in breast lipofilling procedures. METHODS: All patients who underwent breast lipofilling between 2010 and 2022, were identified. Patients were followed for an average of 20 months (range: 3 -173 months). Data including patient demographics, fat preparation methods, and outcomes were extracted from clinical records. Patient satisfaction was assessed using a modified BreastQ questionnaire, and complications were recorded from postoperative follow-ups. RESULTS: We included 572 breast lipofillings (7 male; 374 female) with a mean age of 45.34 ± 12.2 years (range 14-79). Patient demographics did not differ statistically significantly (p = 0.85). A total of 464 lipofilling interventions (82.8%) were eligible for analysis, as 99 lipofilling interventions (87 patients) were lost to follow-up or refused to participate in the questionnaire. The surgical site complication rate of the study was as follows: CELT (8.0%), filtration (14.9%), and sedimentation (16.4%). Specific complications for CELT included oil cyst formation (4.8%), hematomas (1.6%), no infections (0%), and postoperative wound healing disorders (1.6%). The CELT method resulted in a significantly higher patient satisfaction rate (p < 0.001) with a mean score of 1.70 (where 1 indicates very satisfied) and the lowest complication rate of 8.0%. Satisfaction rates for other techniques were as follows: Filtration (2.31) and Sedimentation (mean score of 2.43). In subgroup analyses, outcomes did not differ significantly between radiated and non-radiated patients in this cohort (p ≥ 0.06). CONCLUSION: The Cell Enriched Lipotransfer (CELT) method has emerged as a highly effective fat preparation technique for breast lipofilling, demonstrating enhanced patient satisfaction and a lower incidence of complications. However, further validation through larger-scale, prospective studies is essential to confirm these findings and establish robust evidence.

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