Advanced Biomedical Research

Obesity phenotypes and resorption percentage after breast autologous fat grafting: Rule of low-grade inflammation

Authors

1 Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, Italy; Department of Plastic and Reconstructive Surgery, Catholic University, Tirane, Albania

2 Department of Biomedicine and Prevention, Division of Clinical Nutrition and Nutrigenomics, University of Rome Tor Vergata, Rome, Italy

3 Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, Italy

Abstract

Background: One of the main reasons why the breast fat grafting was questioned is that there may be lipofilling resorption. In the literature, the resorption rate reported over the 1st year is highly variable (20–90%).
Objective: The aim of this work was to identify the biochemical and clinical parameters, which increase fat graft maintenance in breast reconstruction.
Materials and Methods: A sample of 19 patients was treated with fat grafting mixed with platelet-rich plasma. A complete screening of anthropometry, body composition, and blood biochemical parameters was assessed using the standardized equipment. Pre- and post-operative evaluation was performed, which included a complete clinical examination, photographic assessment, nuclear magnetic resonance imaging of the soft tissue, and ultrasound. The follow-up period was 2 years.
Results: The authors divided the results into two types of patients: “responder” and “not a responder.” In the “responder” group patients with normal weight, gynoid fat distribution, obese, with normal blood biochemical parameters, and atherogenic indices but with high preoperative values of platelet-to-lymphocyte ratio (PLR) (174.49) and neutrophil-lymphocyte ratio (NLR) (2.65) showed a greater increase of fat graft maintenance at 6 and 12 months after the last lipofilling session. In the “not responder group” patients with overweight, android fat distribution, obese, high values of atherogenic indices, but with normal preoperative NLR and PLR ratios showed a lower fat graft maintenance at 6 and 12 months.
Conclusion: We assume, the problem of fat resorption may be resolved by analysis of body composition and by examine the predictive role of preoperative markers of low-grade inflammation.

Keywords

1.
Hu G, Bouchard C, Bray GA, Greenway FL, Johnson WD, Newton RL Jr., et al. Trunk versus extremity adiposity and cardiometabolic risk factors in white and African American adults. Diabetes Care 2011;34:1415-8.  Back to cited text no. 1
    
2.
Carey VJ, Walters EE, Colditz GA, Solomon CG, Willett WC, Rosner BA, et al. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The nurses' health study. Am J Epidemiol 1997;145:614-9.  Back to cited text no. 2
    
3.
Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982;54:254-60.  Back to cited text no. 3
    
4.
Snijder MB, Flyvbjerg A, Stehouwer CD, Frystyk J, Henry RM, Seidell JC, et al. Relationship of adiposity with arterial stiffness as mediated by adiponectin in older men and women: The Hoorn study. Eur J Endocrinol 2009;160:387-95.  Back to cited text no. 4
    
5.
Snijder MB, Dekker JM, Visser M, Bouter LM, Stehouwer CD, Yudkin JS, et al. Trunk fat and leg fat have independent and opposite associations with fasting and postload glucose levels: The Hoorn study. Diabetes Care 2004;27:372-7.  Back to cited text no. 5
    
6.
Herishanu Y, Rogowski O, Polliack A, Marilus R. Leukocytosis in obese individuals: Possible link in patients with unexplained persistent neutrophilia. Eur J Haematol 2006;76:516-20.  Back to cited text no. 6
    
7.
Lumeng CN, Saltiel AR. Inflammatory links between obesity and metabolic disease. J Clin Invest 2011;121:2111-7.  Back to cited text no. 7
    
8.
Di Renzo L, Del Gobbo V, Bigioni M, Premrov MG, Cianci R, De Lorenzo A. Body composition analyses in normal weight obese women. Eur Rev Med Pharmacol Sci 2006;10:191-6.  Back to cited text no. 8
    
9.
De Lorenzo A, Bianchi A, Maroni P, Iannarelli A, Di Daniele N, Iacopino L, et al. Adiposity rather than BMI determines metabolic risk. Int J Cardiol 2013;166:111-7.  Back to cited text no. 9
    
10.
Wang J, Thornton JC, Bari S, Williamson B, Gallagher D, Heymsfield SB, et al. Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr 2003;77:379-84.  Back to cited text no. 10
    
11.
Millán J, Pintó X, Muñoz A, Zúñiga M, Rubiés-Prat J, Pallardo LF, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 2009;5:757-65.  Back to cited text no. 11
    
12.
Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395:27-31.  Back to cited text no. 12
    
13.
Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome – A new worldwide definition. Lancet 2005;366:1059-62.  Back to cited text no. 13
    
14.
Coleman SR. Structural fat grafting: More than a permanent filler. Plast Reconstr Surg 2006;118 3 Suppl: 108S-20S.  Back to cited text no. 14
    
15.
Coleman SR. Long-term survival of fat transplants: Controlled demonstrations. Aesthetic Plast Surg 1995;19:421-5.  Back to cited text no. 15
    
16.
Coleman SR. Structural fat grafts: The ideal filler? Clin Plast Surg 2001;28:111-9.  Back to cited text no. 16
    
17.
Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: Safety and efficacy. Plast Reconstr Surg 2007;119:775-85.  Back to cited text no. 17
    
18.
Niechajev I, Sevcuk O. Long-term results of fat transplantation: Clinical and histologic studies. Plast Reconstr Surg 1994;94:496-506.  Back to cited text no. 18
    
19.
Hörl HW, Feller AM, Biemer E. Technique for liposuction fat reimplantation and long-term volume evaluation by magnetic resonance imaging. Ann Plast Surg 1991;26:248-58.  Back to cited text no. 19
    
20.
Chajchir A. Fat injection: Long-term follow-up. Aesthetic Plast Surg 1996;20:291-6.  Back to cited text no. 20
    
21.
Ersek RA. Transplantation of purified autologous fat: A 3-year follow-up is disappointing. Plast Reconstr Surg 1991;87:219-27.  Back to cited text no. 21
    
22.
Lewis CM. The current status of autologous fat grafting. Aesthetic Plast Surg 1993;17:109-12.  Back to cited text no. 22
    
23.
Chan CW, McCulley SJ, Macmillan RD. Autologous fat transfer – A review of the literature with a focus on breast cancer surgery. J Plast Reconstr Aesthet Surg 2008;61:1438-48.  Back to cited text no. 23
    
24.
Amar O, Bruant-Rodier C, Lehmann S, Bollecker V, Wilk A. Fat tissue transplant: Restoration of the mammary volume after conservative treatment of breast cancers, clinical and radiological considerations. Ann Chir Plast Esthet 2008;53:169-77.  Back to cited text no. 24
    
25.
Goodpasture JC, Bunkis J. Quantitative analysis of blood and fat in suction lipectomy aspirates. Plast Reconstr Surg 1986;78:765-72.  Back to cited text no. 25
    
26.
Carpaneda CA. Study of aspirated adipose tissue. Aesthetic Plast Surg 1996;20:399-402.  Back to cited text no. 26
    
27.
Gentile P, Di Pasquali C, Bocchini I, Floris M, Eleonora T, Fiaschetti V, et al. Breast reconstruction with autologous fat graft mixed with platelet-rich plasma. Surg Innov 2013;20:370-6.  Back to cited text no. 27
    
28.
Zheng DN, Li QF, Lei H, Zheng SW, Xie YZ, Xu QH, et al. Autologous fat grafting to the breast for cosmetic enhancement: Experience in 66 patients with long-term follow up. J Plast Reconstr Aesthet Surg 2008;61:792-8.  Back to cited text no. 28
    
29.
Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature 2006;444:881-7.  Back to cited text no. 29
    
30.
Kang SM, Yoon JW, Ahn HY, Kim SY, Lee KH, Shin H, et al. Android fat depot is more closely associated with metabolic syndrome than abdominal visceral fat in elderly people. PLoS One 2011;6:e27694.  Back to cited text no. 30
    
31.
Oka R, Miura K, Sakurai M, Nakamura K, Yagi K, Miyamoto S, et al. Impacts of visceral adipose tissue and subcutaneous adipose tissue on metabolic risk factors in middle-aged Japanese. Obesity (Silver Spring) 2010;18:153-60.  Back to cited text no. 31
    
32.
Després JP. Cardiovascular disease under the influence of excess visceral fat. Crit Pathw Cardiol 2007;6:51-9.  Back to cited text no. 32
    
33.
Dandona P, Aljada A, Bandyopadhyay A. Inflammation: The link between insulin resistance, obesity and diabetes. Trends Immunol 2004;25:4-7.  Back to cited text no. 33
    
34.
Cancello R, Henegar C, Viguerie N, Taleb S, Poitou C, Rouault C, et al. Reduction of macrophage infiltration and chemoattractant gene expression changes in white adipose tissue of morbidly obese subjects after surgery-induced weight loss. Diabetes 2005;54:2277-86.  Back to cited text no. 34
    
35.
Trayhurn P. Hypoxia and adipose tissue function and dysfunction in obesity. Physiol Rev 2013;93:1-21.  Back to cited text no. 35
    
36.
Dalmas E, Clément K, Guerre-Millo M. Defining macrophage phenotype and function in adipose tissue. Trends Immunol 2011;32:307-14.  Back to cited text no. 36
    
37.
Haukeland JW, Damås JK, Konopski Z, Løberg EM, Haaland T, Goverud I, et al. Systemic inflammation in nonalcoholic fatty liver disease is characterized by elevated levels of CCL2. J Hepatol 2006;44:1167-74.  Back to cited text no. 37
    
38.
Smits MM, van Geenen EJ. The clinical significance of pancreatic steatosis. Nat Rev Gastroenterol Hepatol 2011;8:169-77.  Back to cited text no. 38
    
39.
Park SH, Kim BI, Yun JW, Kim JW, Park DI, Cho YK, et al. Insulin resistance and C-reactive protein as independent risk factors for non-alcoholic fatty liver disease in non-obese Asian men. J Gastroenterol Hepatol 2004;19:694-8.  Back to cited text no. 39
Advanced Biomedical Research
Volume 2016, August
August 2016
Pages 1-7