Water Jet Assisted Liposuction (BodyJet) and Fat Grafting

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Water Jet Assisted Liposuction (BodyJet) and Fat
Grafting

• LLC NIKE-MED Satellite Symposium
• Moscow - 13th of December 2012

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Terms
WAL Water-Assisted Liposcution
Water-Jet Assisted Liposuction J-AFT
Jet-Assisted Fat Transfer BEAULITM
Berlin Autologous Lipotransfer A method for
large-volume fat grafts by means of
water-assisted liposuction (BodyJetR) and
reinjection of the fat after separation from
superfluous water by means of the LipoCollectorR

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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Dr. Daniel MünchLiposuction since 1993 (5000
Op)Fat Transfer since 2010 (110
Op)liposuction.ch
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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Gustav Adolf Neuber (1850-1932)
First Report on Fat Auto-Grafting in Humans in
1893
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Meeting of the Deutsche Gesellschaft für
Chirurgie, April 12-15, 1893
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• Holländer, 1910 Partial breast reconstruction
  through injection of autologous adipose tissue
• Peer, 1950 Study of Loss of weigth and volume in
  human fat graft
• After Introduction of liposuction Fischer,
  Illouz, Fournier (1983) adipose tissue
  transplantation come into vogue

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• Strong upswing in scientific investigation of
  autologous fat transfer with publications and
  research by Chajchir (1986, 1989), Coleman (1998,
  2001), Delay (2005, 2009) and Rigotti (2008,
  2009)
• Results depend essentially on the methode

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. structural fat grafting is going to
revolutionize breast surgery and completely
change the way plastic surgeons deal with the
female breast."-- Sydney Coleman, M.D.
Original technique (LipoStructure) used by
Coleman in bilateral breast enlargement took at
least 5 7 h
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• Coleman Successfull transplant of fat is
  possible in principle
• Problem facility for harvesting large quantities
  in realistic surgery time

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WAL Technique for cell friendly harvesting of
fat cell particles which would reduce operation
time and result in a high integration rate
Reinjection of the fat after separation from
superfluous water by means of the LipoCollectorR

Water-Jet Assisted Liposuction (BodyJetR )
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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Fat Grafting Methode should be

• Clinically safe
• Easy to perform
• Fast to perform
• Render reproducible results

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Blood supply
Size of the fat droplets
0-300µm survival
300-550µm regeneration
550µm necrosis/cysts
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Fat droplets of until1mm diameter are save
Survival
max. 1mm
Regeneration
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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Patient Selection
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Patient Selection
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Patient Selection
Patients with lipodystrophy in the trunk/thighs
and small breasts is are good candidates
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Patient Selection be aware

• Slim, young women with small breasts and tight
  skin envelope, BMI under 19
• Unrealistic expections
• Is there enough fat (and money) for later
  transfers?
• Prevoius surgery, scarring
• Weight loss after the transfer

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Patient Information Volume gain

• 200ml injected Volume
• 75 pure Fat, 25 Water Volume 150ml
• Uptake 70 Volume 105ml

Volume gain about half of the injected
volume Shrinking max. loss in 3 weeks, final
result in 2-3 months
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Volume gain
Water
Not Absorbed
200ml injected Volume
Pure Fat
105ml Volume gain
Volume gain
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Volume gain
100ml
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Patient Information

• General information about possible cyst formation
  or calcification
• Mammogram
• Infections
• Bleeding

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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Prevent Cooling

• Klein Solution 350C
• Patient warming blankets (Inditherm, Bair Hugger)

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Prophylaxis

• Antibiotic for 7 days
• Low dose Liq. for 3 days

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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Klein Standard Tumescence Solution
(Body temperature)
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Infiltration(Cannula 2mm)
Fragmentation
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Additional Analgesia

• Entonox (50 nitrous oxide 50 oxygen)
• Analgesic anxiolytic agent
• Effective
• Rapide
• Patient acceptable
• Safe (no anesthesiologist!)

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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Cannula
Applicator

• BodyJet

Collector
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Water Jet Harvest

• Water carries the delicate fat tissue (pulsing
  water jet, 30bar, 90ml/min, 300 angle)
• Small openings (0,9mm) tiny parcels of fatty
  tissue
• Reduced negative pressure (-0,5bar)
• Gentle movements

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Infiltration and aspiration
Result
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Water Jet Harvest

• Residue of 30 fluid permits easy reinjection and
  leads to a uniform distribution of the fat in the
  tissue
• Duration of the invervention only 1 ½ - 2 h

Ueberreiter BEAULI Thieme 2010
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Water Jet Harvest

• Water Jet Liposuction yields harvested fat of
  consistent quality (immediatly re-use without
  centrifugation)
• Small cell packages containing adipocytes and
  pre-adipocytes are transferred

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No Seperation of Stem Cells

• 500ml of fat must be extracted in addition
• The enzymatic preparation process takes 3h
• Additional costs

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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting/LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Lipo Collector
From Patient
to BodyJet
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LipoCollectorTM
Prefilter (removing fibrous elements)
Sieve (Seperate fat/fluid)
Ueberreiter BEAULI Thieme 2010
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LipoCollectorTM
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Lipo Collector
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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Fat Injection

• Cannula
• Diameter 2.00mm
• Lenght 150mm
• 2 Lateral Eyes

• Syringue
• 10ml
• Luer Lock

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Fat Filling

• 2/3 in the subcutis
• 1/3 in the muscle and retroglandular
• Not in the glandular tissue
• Decollté
• Compensating for asymmetry

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Fat Filling

• 2/3 in the subcutis
• 1/3 in the muscle and retroglandular
• Not in the glandular tissue
• Decollté
• Compensating for asymmetry

2/3
Gland
1/3
m.pectoralis
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Cave seeding fat lumps
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Yoshimura/Autologous Fat Transfer Shifmann (Edit)
Springer 2010

• Fan shaped
• Several planes
• Rotating the cannula
• Strung like pearls

• 3D-Filling
• Not overfill (to much fat kills the
  fat)
• Patient in a upright 450 position

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• Fan shaped
• Several planes
• Rotating the cannula
• Strung like pearls

• 3D-Filling
• Not overfill (to much fat kills the
  fat)
• Patient in a upright 450 position

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Fat Filling
Leave the breats soft to much fat leads to
necrosis! High pressure Reduced circulation
For more volume 2 Operations
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Postoperative

• Injection site Plaster Strip
• Circular cotton bandage around the chest to avoid
  local cooling for 3 days

• No bra or a wide nursing bra without any
  compression
• Antibiotic for 3 days (Cephalosporin)
• Analgesics (Paracetamol)

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Postoperative

• No compression!

• Keep breasts warm!

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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Complications

• Large portions of fat
• Poor perfusion Necrosis
• Pressure
• Oil Cysts
• Calcifications

With the use of digital mammography MRI such
changes can be easily distinguished from
malignant changes
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Complications

• Haematoma formation
• Infections
• Subcutaneous granulomas

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Risk of Developing Breast Cancer

• Cancer originates in the glands, outside the
  subcutaneous adipose tissue
• In current state of data, an increased risk of
  cancer through fat transfer is unlikely and has
  not been recorded to date

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Task Force ASPS
1987 The Committee is unanimous in deploring
the use of autologous fat injection in breast
augmentation.
1992 strongly condems the use of fat injection
for breast enlargement.
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Task Force ASPS
2009 Fat graft can be considered a safe method
of breast augmentation. The need of sterile
technique should be emphasized.
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Task Force ASPS
2009 The result may vary depending on the
surgeons technique and experience with the
procedure.
There are no reports sugesting an increased risk
of malignacy associated with fat grafting.
Plastic and Reconstr Surg 2009, 1241 p 272-80
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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anästhesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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Large volume fat transfers for Breastaugmentation
my experience

• One surgeon study
• September 2010 May 2012
• 93 Breast-Transfer Operations
• 81 Patients
• Age 19 - 62 years (Ø 36,5 years)
• BMI 18,6 29,8 (Ø 22,7)

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Large volume fat transfers for Breastaugmentation
my experience

• 45 Patients correction of asymmetrie
• 3 Patients unilateral
• 11 Patients twice
• 1 Patient three times
• Injected Volume 140 ml 540 ml (Ø 340ml)
• Follow up 1 20 months (Ø 5,1 months)
• No Complications

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Patient Satisfaction
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Subjective Assessment
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• My Person
• History of Fat Transfer
• Principles of Fatgrafting
• Patient Selection and Information
• Precautions
• Anaesthesia
• Fatgrafting with WAL/BodyJet (HumanMed)
• Fat Collecting /LipoCollector (HumanMed)
• Fat Injection
• Complications
• My Results
• Conclusion

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J-AFT Advantages

• Simple collection process
• Gentle water-Jet releases fat
• Low suction force
• No centrifugation, no washing
• Avoids excess handling of fat
• No exposure to oxygen
• No waiting fat is ready for transfer
• Excellent natural filler, no scars

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• it works

• Good selected patients are very happy
• after 110 procedures no complications
• naturally improvement in breast size and form,
  more firmness and fullness for every patient

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Contraindication

• Unrealistic expectations (great volume, desire
  absolute increase of cup size)
• Denial of multiple procedures
• Dislike liposuction
• BMI under 19

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Caution

• Stay modest more
• seeds on the same ground do not mean better
  harvest
• overfilling ? necrosis overgrafting ?
  loosing fat

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Conclusion

• J-AFT using WAL (BodyJet) combined with
  LipoCollector for harvesting, filtering and
  transferring of autologous fat tissue represents
  a very efficient unique technology for fat
  grafting