| אודותינו | חטיבות | מוצרים | נציגויות | אסתטיקה רפואית | יצירת קשר | English |
|
||||||
|
|
BEAULI- a new method for breast augmentation by lipotransfer
Question: What is meant by BEAULI?
Dr. Ueberreiter: BEAULI means „Breast Augmentation by
Lipotransfer”
and represents a new me- thod of fat grafting for breast
augmentation.
Question:
What has triggered the introduction of this new fat
ransplantation method?
Dr. Ueberreiter: Through the publications of Sydney Coleman in
New York, micro-fat grafting has been
gaining popularity since the mid-90s and is now being
used worldwide for the correction of tissue deficits in the
facial area. It wasn’t long
before, the use of autologous fat for breast enhancement as an
alternative
to silicone implants was also
being discussed.
Question: Have advances
since been made in the use of this method
for breast augmentation?
Dr. Ueberreiter: In March 2007, Coleman presented the results of
a study on breast augmentation with autologous fat (1); Zocchi
and Delay, from Italy and France, published additional findings.
Since
then, autologous fat transfer has been generally accepted as a
surgical option for breast enlargement.
Question: What are the
disadvantages of previously used methods
and the advantages of the new
method you have developed?
Dr. Ueberreiter: The
previously used methods of micro-fat grafting
with intermediate steps such as
centrifugation are very time-consuming
and associated with long surgery
times. Whereas fat cells that have
been aspirated from tissues using the
body-jet® are already washed,
and the blood content of the aspirate
is very low. In our studies, we
have been able to prove that this fat
contains the same number of vital
fat cells and fat stem cells (pre-adipocytes)
as the fat harvested using
the Coleman method. This is the first
method for fat harvesting that
requires only slightly more time than
the liposuction itself while significantly
decreasing the overall procedure time
of breast augmentation.
Question: Can you describe
the method more detailed?
Dr. Ueberreiter: Fat removal
with the body-jet® represents an especially
gentle form of liposuction, as has
since been substantiated in various publications, e.g. by Stutz,
Araco and Meyer (2). We have been using this system successfully
since 2004.This success led to the idea of constructing a
special collection
system with additional filter
functions for the sterile collection of fat, an idea that was
successfully implemented, thanks to the cooperation of human med
AG. When
the
LipoCollector™ II is used in combination with the body-jet®, the
filtered, washed fat no longer has to be centrifuged and can be
used for re-injection without further
preparation.
Question: For which
patients is this method most suitable?
Dr. Ueberreiter: The patients treated with this technique
basically fall
into three groups. The first
group includes patients with primarily aesthetic
desires for breast enlargement. Also,
the procedure is very appropriate
for filling defects and correcting
asymmetries as well as in cases where
the patient cannot tolerate silicone
implants in the long term and the
implants must be removed. A third and
very important area of application
is breast reconstruction following
breast cancer surgery.
Question: What about the
survival rate of the transplanted cells?
Dr. Ueberreiter:
After approximately six weeks about 80% of the transplanted
cells have been integrated into the host tissue. These
integrated cells will remain in the tissue permanently.
Question: Are there still
problems associated with the masking or mimicking of
possible tumor tissue in imaging procedures?
Dr. Ueberreiter: No. There have been numerous reports published
on this topic since the issue was first raised. The quality of
diagnostic imaging has been improved significantly over the past
10 years.
Question: Dr. Ueberreiter, you are preparing to
you have achieved with this
new method?
Dr. Ueberreiter: Since October 2007, we have been conducting a
prospective controlled study on breast augmentation; the results
we have seen with about 50 patients, who have undergone the
procedure to date are very promising.
These results are being
examined using various tests, including imaging
procedures (MRI), both prior to and
six months after the surgery, with volumetric evaluation. Also,
a recording of results over two years will be done. After
completion of the documentation we will analyze and publish
these data until end of
the year. It will be the first time
that exact volumetric determinations of integrated fat cells are
established in a study.
Question: Which patient
groups are included in this publication?
Dr. Ueberreiter: Based on our extended experience with
lipotransfer
during reconstruction
following cancer related breast amputation, and
refilling of volume after removal of silicone implants,
we are preparing several publications on this subject.
The third large group are primarily aesthetic procedures
in patients with
micromastia or hypoplasia. A new study group will be treatments
with concomitant firming and autologous fat grafting. The large
sub groups will be published separately.
Question: Can you give us
some first results of your study on aesthetic
breast augmentation?
Dr. Ueberreiter: It can be stated that the BEAULI method
functions reliably. I do not have a single case without any gain
in volume. The aesthetic patients often have the
desire for relatively large
transplantations of fat, so that we normally do two fat
grafting procedures within three months. As a rule of
thumb, it can be said that a half cup size per treatment
is realistic.
Question: Any adverse
effects or complications so far?
Dr. Ueberreiter: None up to now, fortunately. There may be mild
hematoma occasionally, and minor pain. Pain has been registered
on the first postoperative day, with a value of 3 on a scale of
1 to 10 in the area of the breast.
Question: Why do you define
BEAULI as a new standard?
Dr. Ueberreiter: Meanwhile there is a big discussion on fat
transplantation
into the breast. Having been
a taboo topic for 20 years in most countries, we are
concerned about uncontrolled methods of fat grafting.
Inappropriate attempts to transplant large volumes of
fat collected by unsuitable techniques may cause
Effect of the water-jet viewed by the
electron microscope
In a recent investigation at the
University of Greifswald, the effect
of the body-jet® water spray has
been studied on different tissue structures including
• skin, adipose tissue,
adjacent muscle tissue, blood vessels and nerves.
All samples were exposed to the five application ranges (Range 1
to 5) of the bodyjet ® water jet with a 3.5 mm infiltration
cannula. The duration of the saline spray application was 30
seconds within a space of one centimeter in all five ranges.
This procedure represents a substantially increased impact on
the tissues, as normal
application times would only be up to 5 seconds and while moving
the cannula.
Special attention was focused on the affection of vessels and
nerval structures.
The researchers
conclude that
“no vessels or
nerval structures were destroyed in the corium/epidermis or in
the muscle tissue, even with deep penetration. Our findings
indicate th
would lead to
a tightening of the tissue which could be seen as a firming
effect.”
The impact of the body-jet® water spray on vascular and nerval
structures was analyzed by immunohistochemical staining. Samples
representing all three specimens
vessels and nerves were
marked by CD34 and S100 in order to investigate them for
lesions of that
structures.
„In all specimens
neither In the dermis nor in the subcutis or adjacent muscles a
rupture or lesion of vessels or nerves was observed.”
According to the
findings, „a large range of action of the water jet was apparent
in pure adipose tissue. Connective tissue strands in the
subcutis and corium/ epidermis impeded the water jet, depending
on the thickness of the fibres. Multiple successive connective
tissue strands effectively shortened the range of action. No
destruction of connective tissue was seen.”„Penetration of water
into the corium and/or the epidermis would lead to edema, which
would subsequently be drained via the lymph vessels.
The present
findings suggest that no scar formation is to be expected.”
„Wherever
strands of connective tissue in the subcutis do not cushion the
water jet before it reached the muscle layer, thin, diffuse
distribution inside and between the individual muscle fibers
would occur. Here, too, edema would result from the water
penetrating the muscle tissue. This water would drain over the
space of a few days through the lymph vessels.However, there
could be transient swelling in the muscle fibers and probably
slight tenderness in the muscles for a few days.”
Investigation on
tissue effects of water-assisted liposuction with the body-jet®
Nerves; S100 nerval staining supramuscular
Blood vessels; CD34 endothelium staining, subdermal
Blood vessels; CD34 endothelium staining, subcutis
Nerves; S100 nerval staining, dermis
negative effects, for example oil cysts and calcifications. In
order to distinguish between the different methods, we have
given a name to our method of lipotransfer. We assume that with
the BEAULI method there will be no negative side effects like
oil cysts and calcifications.
Question: Are the body-jet® and the LipoCollector® essential for
the BEAULI standard?
Dr. Ueberreiter: Yes, the body-jet® and the LipoCollector® are
an essential entity, because the fat being “washed out” gently
with water by the body-jet® under low negative pressure, has an
especially good quality. By means of the LipoCollector® the fat
is harvested, separated from the water, and than re-injected
without
centrifugation in a sterile
and very convenient way. Also, the remaining
water content helps to distribute the
fat within the subcutaneous layer of fat tissue in an especially
even way.
Question: Do you use any additional techniques besides the
bodyjet
® and LipoCollector®? Do you use centrifugation?
Dr. Ueberreiter: If smaller volumes are required, for example
for injections into facial eye lids and wrinkles, we do
centrifuge the fat in order to achieve a more dense quality. For
fat transfer into the breast we do not centrifuge, because the
concentrated fat is less evenly distributed.
Question: Which cannulas do you use for liposuction and why?
Dr. Ueberreiter: During liposuction for re-injection we use the
3.8 mm
stainless steel Rapid Cannula. The reason is that with a 3.5 mm
cannula,the openings are too small so that due to the low
suction pressure of only 0.5
bar, the cannula would get blocked too often. Whereas with a
larger cannula
the fat portions would be too
large. I am interested in harvesting small fragmentized
lumps of fat which is distributed much better in the
target tissue.
Question: What kind of cannulas do you use for re-injecting the
fat?
Dr. Ueberreiter: I use the 2 mm infiltration cannula designed by
ourselves which are part of the BEAULI set.
Question: How much fat
volume can/should you inject into the breast,
and do you over-correct?
Dr. Ueberreiter: Fat cells are very fragile. I like to compare
fat cells with the foam of beer. Imagine you would have to
aspire this foam into a syringe and than inject it somewhere
else that is quite delicate. If you try to over-correct by
applying too much pressure to the fat cells, many of the
adipocytes will burst, thus leading
to a worse result as compared
to the application of too little volume. It
has been proven to be reasonable to
inject just as much as can be taken
up by the breast without filling and
distending the tissue excessively.
Question: Apparently the fat cells
perish after four to six weeks. Does
this mean that you also transplant
stem cells with the BEAULI method?
Dr. Ueberreiter: As a matter of course we do transplant pre-adipocytes,
because otherwise the whole method would not be effective. If
you would only transferre adipocytes without any pre-adipocytes,
after apoptosis of the mature adipocytes your result would be
gone within six weeks.
Question: Are the stem
cells destroyed by the water-jet?
Dr. Ueberreiter: The stem cells are so microscopically small,
that they cannot be damaged by the water-jet. During liposuction
with the waterjet we harvest whole cell clusters of
approximately 50 to 200 adipocytes. Within the tissue structure
and
between the adipocytes are located the fat stem cells which are
not harmed by the water-jet.
Question: Which local anaesthetic do you use and how do you
prepare
the solution?
Dr. Ueberreiter: We use Klein´s tumescent solution, as published
by Klein in 1992 (3) in order to have an internationally
comparable composition. This solution contains 500 mg Lidocaine
per liter, 1 mg Adrenalin and 12.5 ml sodium bicarbonate as a
buffer.
Question: Are local anaesthetics harmful regarding augmentation
and fat cell survival?
Dr. Ueberreiter: We published a study on the influence of local
anaesthetics on the vitality of pre-adipocytes. In this study it
was concluded that the toxicity of local anaesthetics was very
variable, and that a good survival rate of adipocytes is found
for our solution containing the mentioned concentrations.
Question: Do you recommend
warming of the rinsing solution, and
if yes, to which temperature should
it be warmed?
Dr. Ueberreiter: The rinsing solution should definitely be
warmed to body temperature, because fat cells are sensitive to
temperature.
The oil in the fat cells may
congeal at temperatures below 20°C (68°F),
and thus could lead to rupture of the
cell membrane. As a certain cooling
occurs anyway during the
infiltration, it is necessary to warm the solution
before using it. Apart from that it
is much more convenient for the patient instead of being treated
with cold room-temperature solution.
Question: What is your
opinion regarding negative effects of oxygen
and light on the fat cells?
Dr. Ueberreiter: If fat is exposed to oxygen, after several
hours, oxidation
may occur. However, the fat
in the fat cells is protected by the cell membranes so I
do not expect any negative effect from oxygen. A
negative impact of light on fat cells is not known of.
Question: Do you freeze fat
to use it at a later stage?
Dr. Ueberreiter: As mentioned before, the intracellular oil will
congeal below
20°C (68°F). The melting
point may be compared approximately with that
of margarine. When the oil congeals,
the cell membranes break down. If
you freeze and unfreeze the fat you
will get a non-vital fat pulp, possibly
some individual pre-adipocytes would survive, but certainly no
adipocytes.
Question: What do you recommend postoperatively? Compression
bandage, warmth, analgetics?
Dr. Ueberreiter: Postoperatively, the
patient is covered by a warming blanket.
The breast is bandaged by a thick cotton batting. No
compression is applied as the fat cells are extremely
sensitive to pressure, as we could observe earlier.
Question: Dr. Ueberreiter, can you briefly summarize the
advantages of
the new BEAULI method?
Dr. Ueberreiter: The advantages lie in the fact that the fat can
be harvested
(liposuction) and transferred (fat grafting) during a
single operation.
The entire procedure takes less than two hours. Furthermore, the
vitality
and the integration rate of the fat cells harvested using this
gentle method
are very good. The entire surgery can be performed on an
outpatient
basis under local anesthesia with light sedation.
Hints on technical aspects Sydney
Coleman, A. P. Saboeiro:
Fat Grafting to the Breast R evisited:
Safety and Efficacy Conclusions:
Given these results and reports of other plastic surgeons, free
fat grafting should be considered as an alternative or adjunct
to breast augmentation and reconstruction procedures. It is time
to end the discrimination created by the 1987 position paper and
judge fat grafting to the breast with the same caution and
enthusiasm as any other useful breast procedure.
Clinical Reports on the use of water-assisted lipoplasty (WAL)
with the body-jet®
Water-assisted lipoplasty with the body-jet® is being described
in the literature for the first time with 280 patients treated
from October 1999 on.(1). Since then, the bodyjet ® is used for
lipoplasty in Europe (e.g. in the UK, The Netherlands, Spain,
Switzerland, Austria, Germany), in the USA, in Asia
(e.g. Japan, Korea, Hong
Kong, Singapore), in Australia, Saudi Arabia, Iran, Brazil,
Venezuela, Australia and many other countries. Clinical
publications and postmarket surveillance
reporting do not indicate any case of a major adverse
event.
Clinical data on the safety of WAL with the body-jet®
For WAL with the body-jet® the incidence of complications and
adverse events is very low.
In a study by Taufig (1), it is reported that no infections
occurred in any of the 280
patients. In one case of 280 a hematoma appeared in the medial
area of the knee. In none of the cases was there a seroma that
could be clinically established. The occurrence of ecchymosis
was very rare and in these few cases minimal.
The previous sensitivity of the skin of the treated
areas
returned after 3 days to 6 weeks. (1)
In a prospective randomized
trial of postoperative pain by Araco et al. comparing
bodyjet ® WAL („power water-assisted“) and SAL („traditional“)
liposuction (2), no postoperative events and no cases of
hypovolemia, hemorrhages or
infections were reported for WAL and SAL. However,
statistical differences were found for ecchymosis measurements,
bruising reduction, and pain measurements, as well as the number
of daily analgesic pills.
The authors state that the „comparison of the pain measurements
showed a significant difference, with average values 4.8-fold
lower for power waterassisted
(WAL body-jet®) than for traditional liposuction (SAL) (p < 0.05).Additionally,
after 4 days, 87% (28/32) of patients treated with power
water-assisted liposuction
(body-jet®) were completely free of pain versus 3.6% (1/28) of
those treated with traditional liposuction.”(2) „Ecchymosis
measurements also were significantly lower
for the patients who underwent power water-assisted (body-jet®)
rather than traditional liposuction (p < 0.05), and the
differences were significant in every postoperative
measurement.”(2) Araco et al.: „Both techniques showed a
dramatic bruising reduction at postoperative day 5. However, the
scores were
significantly lower for the power water-assisted
liposuction (body jet®) in every
assessment during the first 5 postoperative days.“(2) In another
study by Man and
Meyer (3), the authors have found in more than 800 treatments
with the body-jet® that
• „It is notable that patient safety has increased considerably,
even in extensive
procedures.”
• „There is significantly reduced pain-related impairment during
and after the procedure compared with standard tumescent
technique. Patients recover quickly and return to normal daily
activities rapidly.”
• „Considerably less intraoperative swelling allows the surgeon
to realize the target
result with greater precision.”
• „Compared with the quantity of tumescent solution used in
conventional manual
lipoplasty, an average of 20% to 30% was used in preinfiltration”
(when using
the body-jet®)
• „The length of time tumescent solution remains in the tissue,
as well as the
resulting absorption times, are all considerably lower for the
recommended infiltration solutions (when using the body-jet®)
compared with all other
tumescence-based lipoplasty techniques.” (3) These last comments
may
have an aspect regarding discucssions on cardiotoxicity of
lidocaine and other drugs
after high volume infiltration , and on volume-related
electrolyte shifts that may occur during traditional
liposuctions techniques.
of Water-assisted Liposuction
with the body-jet®
„A paradigm shift has occurred with the introduction of
water-jet assisted
liposuction. For this method no tumescence (firm-elastic
infiltration
condition with high tissue pressure) is necessary. Likewise no
pre-infiltration period for the homogenization of the adipose
tissue is required.
The aspiration procedure is started immediately after the
anaesthesia has
taken effect.”
„The atraumatic, anatomically appropriate procedure of water-jet
assisted liposuction (WAL; body-jet®) available today represents
a promising treatment for lipoedema patients who generally
suffer from severe subjective and objective impairment.
Liposuction treatment can bring long-term improvement if the
operative technique
focuses on lymph vessel preservation. Immunohistological
analyses show
minimal evidence of lymph vessel structures in lipoaspirates.”
„The histological analysis of the aspirates documents a
relatively specific
removal (“apheresis”) of primarily intact lipocytes with low
vascular
amount. In the lipoaspirates of 28 of the 30 investigated
lipoaspirates
(patients), the lipocytes were found to be prodiminantly (>70%)
intact.”
„The analysis
of liposuction aspirates from 60 lower extremities obtained from
the inner knee area, which represents an especially high-risk
region for this type of operation, showed that only minimal or
no injury was done to the lymph vessels, if the liposuction
procedure was performed strictly parallel to the axis of the
lymph collectors. The immunohistochemical evaluation also
confirmed the assumption that a state of tumescence is not
required for the water-jet assisted liposuction (WAL)
procedure preserving the structural integrity of lymph
vessels. It was also
proven that, when the WAL technique is used, the
pre-infiltration period
for the tumescent fluid did not have to be observed.”
Smooth and gentle on blood and lymph vessels – intact lipocytes
In a new study by Stutz and Krahl published in Aesthetic Plastic
Surgery in 2009, the authors are concluding:
Intact lymph vessels in WAL aspirate (D2-40 antibody staining)
Intact lipocyte complexes in WAL aspirate with strands of
collagen- fibrous connective tissue
According to a study by Ueberreiter, Keck and Janke, the
selection of the local anesthetic has a great impact on the
vitality of the pre-adipocytes. In this investigation, human
pre-adipocytes from the fat cell aspirate of 9 patients after
liposuction with the body-jet® have been incubated with a
variety of local
anesthetics. Afterwards the vitality of the cells was
tested by FACS analysis.
Conclusion:
Only Lidocaine and Articaine/Epinephrine are applicable
for the preparation of infiltration solution for liposuctions
for the purpose of autologous fat harvesting.
Results Used local anesthetic Percentage of vital pre-adipocytes
Prilocain 21,7%
Ropivacain 58,8%
Articain, Epinephrin 65,3%
Lidocain 76,5%
Controls (NaCl) 92,8%
The influence of local
anesthetics on the vitality
of the pre-adipocytes
The effect of the bodyjet
® water spray during
infiltration/irrigation.
The loosening of fat cells
– viewed by the electron
microscope.
www.humanmed.com
WAL has left behind the limits of classical TLA
Water-jet assisted liposuction (WAL) has left behind the limits
of classical tumescence liposuction. WAL does not require large
volume preinfiltration,
and does not have to destabilize the cell structure by diffusion
and osmotic processes. The body-jet® spray injection of
tumescence solution leads directly to an oedematous
disintegration of the INTERCELLULAR region. Cell formations are
separated from each other by the gently pressurized saline
spray, thus loosening
the cell structure including their attached stem cells. (please
also refer to page 3 and the publication by Stutz and Krahl)
The LipoCollector™ II collects and separates
The LipoCollector™ II directly separates the superfluous rinsing
solution from the adipocytes. The integrated bypass avoids that
further pressure is exerted on the fat cells. The upwelling of
the fat enables the water to flow downwards. In
addition, the constant water flow prevents the fat from
touching and clogging the built-in filter. The fat
practically swims above the filter. Only by this method
the continuous collection of up to 1 liter of fat is
possible without any further
intervention or processing. Thus the continuous flow of rinsing
solution
(saline) of the body-jet® represents an important function
during the collection of fat. If the LipoCollector™ II is
combined with other liposuction
systems available, like classic TLA or vibration- assisted
liposuction, the LipoCollector™ II runs dry and clogs after a
very short time. With other liposuction techniques available on
the market, additional pressure would have to be applied on the
collected fat to remove the rinsing solution. Liposuction
methods which are
based on destroying fat cells in the body via the application of
energy are contrary to the grafting and transfer of adipocytes.
Of course it appears useless to collect melted fat or oil.
At a glimps
· Up to 1 liter of fat
during a liposuction
· Gentle
· Usually no centrifugation
· Fat for immediate use
· Complete, economical system
The new LipoCollector™ II serves to harvest large amounts of fat
(more precisely micro-fragments of fatty tissue) from the
aspirate of a water-jet assisted
liposuction (body-jet®).
NEW
with pre-filter: even simpler – even better
The new integrated filter basket prefilters the aspirate so that
larger strands of tissue are less likely to block mesh filters
or cannulae. Fat harvesting gets even aesier!
An additional foot ring
adds stability against accidental tilting.
Function
Aspirated fatty tissue and rinsing fluid are separated
immediately by physical buoyancy and gravity; individually
chosen mesh filters complete the separation process. While the
fat is collected inside the sterile LipoCollector™ II, the fluid
is
lead further to the waste bag. |
||||
|
||||||
|
||||||
|
||||||
|
||||||
|
||||||
|
||||||
|
||||||
|
||||||
|
|
||||||
at
no scarring is to be expected after the edema recedes, but a
slight reactive fibrosis is possible. Thisהמידע באתר זה הינו כללי ואינפורמטיבי בלבד. לייעוץ רפואי יש לפנות לרופא מומחה.
אודותינו | חטיבות | מוצרים | נציגויות | אסתטיקה רפואית | יצירת קשר | English
