By Kamakshi R. Zeidler, MD, FACS
Fat grafting has become a popular technique in plastic surgery, and it is useful for both aesthetic and reconstructive augmentation and rejuvenation in many parts of the body. One application of fat grafting that is quickly becoming a standard of care is the use of autologous fat to help rebuild the breasts after mastectomy, where restoring natural contour has a powerful effect on the patient’s well-being, sense of self-worth, confidence, and body image. Many surgeons are also seeing the rejuvenating effect fat transfer has on radiated tissue.
Fat grafting offers the potential to restore a sense of completeness to breast cancer patients. The technique can be used to refine the results of any type of breast reconstruction, whether it is an implant-based reconstruction with some irregularities or an autologous reconstruction that needs some refinement.
Successful autologous fat transfer depends on a variety of factors, including the quality of the recipient site, the way the fat is handled, and the quality of the fat that is removed from the harvest site. The final cosmetic result depends on all of these factors to produce the best and most predictable results. Several techniques are utilized for fat harvesting, yet data are limited on which technique yields the highest quality fat. In general, gentle treatment of the harvested fat is required to limit cell loss while capturing quality fat. At the same time, a gentle technique for fat harvest is critical to prevent contour irregularities and complications at the donor site.
A new technique for fat harvesting, called HydraSolve, has recently been introduced that is based on a unique mechanism of action called Tissue Liquefaction Technology™. Originally, this technology was developed for ophthalmology and for the precision removal of cataracts from the eye. This tissue liquefaction technology eliminates the cutting and shearing forces of traditional fat harvesting procedures, replacing them with gentle aspiration. This is accomplished with the assistance of a warmed and pressurized saline solution. A combination of low thermal energy from the saline stream and mechanical energy produced by a specially designed cannula disrupts protein bonds that join fat cells.
The liquefied fat is comprised of very small clumps of fat cells that are aspirated with the saline solution. The fat can be decanted to separate out a layer of homogeneous fat. Fundamentally, the system’s mechanism of action is specific for the fat tissue, leaving surrounding non-target fat tissue, blood vessels, nerves, and connective tissues intact. The use of low thermal energy heats but does not burn the target tissue.
I have been using HydraSolve in in a variety of aesthetic and reconstructive procedures for about 6 months and have noted three distinct benefits: first and foremost, the results I have seen in patients in terms of natural-looking contours at both the recipient and donor sites have been amazing; second, the harvesting technique is highly efficient; and third, using this technique is less grueling for the surgeon compared with other lipoaspiration techniques.
The Many Implications of Surgical Efficiency
The term “efficiency” in the context of fat transfer using the HydraSolve technique means a couple of different things. It is much faster at removing fat compared with traditional lipoaspiration techniques—and because it is faster and less taxing on the my body, I am able to perform multiple procedures using HydraSolve during a surgical day without concern of damaging my shoulder, elbow, or hands with the repetitive motions. This also means that I can do more operations over the course of a day, because I am extracting more usable fat in less amount of time.
The second aspect of efficiency may also be understood as the efficacy of the fat liquefaction. This has implications both for the harvest and recipient sites—maximizing the aesthetic results while minimizing complications in each site. Successful reconstruction of the breast in a patient after mastectomy should not sacrifice the appearance of the rest of the body. I have been very happy with the very smooth appearance of the donor sites after harvesting fat using this tissue liquefaction technology. The combination of synergistic thermal and mechanical energy yields a homogenous and smooth lipoaspirate devoid of blood, oil, and connective tissue with a high percentage of fat tissue cells that can be separated from saline by gravity separation. I have been happy with the uniform quality and small particle size (1 to 2 mm in size or smaller), which has led to a low incidence of irregularities due to fatty cyst formation and areas of fat necrosis.
In general, the cosmetic results at 6 months after surgery are indicative of the long-term outcome. In observing patients who have undergone breast reconstruction using adjunctive fat grafting utilizing fat harvested through tissue liquefaction, I am seeing good fat retention, indicating good contours at the donor site as a result of placing high quality fat.
I am generally skeptical about incorporating new technology because I pride myself on the results I achieve for my patients—and before trying HydraSolve, I was very satisfied with the cosmetic outcomes my fat grafting patients achieved. But after trying this liposaspiration technique in five consecutive cases, I quickly realized the myriad benefits. The quality of the fat that was harvested was excellent, and the efficiency of the process was unprecedented. I also noticed that the aspiration portion of the procedure did not require as much physical strength, and, therefore, tissue liquefaction was much easier on my hands and body. This means that I can keep doing these procedures that I love without taxing my body.
As I use the technology more and more, the cosmetic benefits have become more apparent. I have started to incorporate HydraSolve into body makeover procedures not only for women undergoing breast reconstruction but also for cosmetic procedures both as adjuncts or as stand alone procedures. I have particularly liked using HydraSolve and tissue liquefaction on thin patients who want fat transfer. In these patients, I feel confident that the donor sites will only be enhanced with a low risk of contour irregularities. Seeing these patients return for follow-up feeling and looking amazing not only in their fat transfer results but in their donor site results has been extremely, extremely rewarding.
Kamakshi R. Zeidler, MD, FACS, is certified by the American Board of Plastic Surgery, and practices aesthetic and reconstructive plastic surgery in the Los Gatos, San Jose, and greater South Bay Area. She received a Bachelor of Arts degree with honors from Rice University and her Doctorate of Medicine at the University of California San Francisco School of Medicine.