Editing Breast augmentation (section)

====Fat-graft injection====
The biologic survival of autologous fat [[Tissue (biology)|tissue]] depends upon the correct handling of the fat graft, of its careful washing (refinement) to remove extraneous blood cells, and of the controlled, blunt-cannula injection (emplacement) of the refined fat-tissue grafts to an adequately [[Circulatory system|vascularized]] recipient site. Because the body resorbs some of the injected fat grafts (volume loss), compensative over-filling aids in obtaining a satisfactory breast outcome for the patient; thus the transplantation of large-volume fat grafts greater than required, because only 25–50 percent of the fat graft survives at 1-year post-transplantation.<ref>{{cite journal | author = Guerney C.E. | year = 1938 | title = Experimental Study of the Behavior of Free fat Transplants | journal = Surgery | volume = 3 | pages = 679–692 }}</ref>

The correct technique maximizes fat graft survival by minimizing [[Cell (biology)|cellular]] trauma during the liposuction harvesting and the centrifugal refinement, and by injecting the fat in small aliquots (equal measures), not clumps (too-large measures). Injecting minimal-volume aliquots with each pass of the [[cannula]] maximizes the surface area contact, between the grafted fat-tissue and the recipient breast-tissue, because proximity to a vascular system ([[Circulatory system|blood supply]]) encourages [[Histology|histologic]] survival and minimizes the potential for fat necrosis.<ref name=Coleman/> Transplanted autologous fat tissue undergoes histologic changes like those undergone by a bone transplant; if the body accepts the fat-tissue graft, it is replaced with new fat tissue, if the fat-graft dies it is replaced by [[Fibrous connective tissue|fibrous tissue]]. New fat tissue is generated by the activity of a large, wandering [[Histiocyte|histocyte]]-type [[Cell (biology)|cell]], which ingests fat and then becomes a fat cell.<ref>Neuhof H. (1923) ''The Transplantation of Tissues'' New York:D. Appleton p. 74</ref> When the breast-filler fat is injected to the breasts in clumps (too-large measures), fat cells emplaced too distant from blood vessels might die, which can lead to fat tissue necrosis, causing lumps, calcifications, and the eventual formation of liponecrotic cysts.

[[File:21327 Dr. Placik Chicago Arlington Heights IL Breast AUgmentation Fat Grafting.jpg|thumb|right|350px|Fat-graft breast augmentation: the pre-operative aspects (left) and the post-operative aspects (right) of a medium-volume non-surgical augmentation]]

The operating room time required to harvest, refine, and emplace fat to the breasts is greater than the usual 2-hour OR time; the usual infiltration time was approximately 2 hours for the first 100&nbsp;cm<sup>3</sup> volume, and approximately 45 minutes for injecting each additional 100&nbsp;cm<sup>3</sup> volume of breast-filler fat. The technique for injecting fat grafts for breast augmentation allows the plastic surgeon great control in sculpting the breasts to the required contour, especially in the correction of [[tuberous breast deformity]]. In which case, no fat-graft is emplaced beneath the nipple-areola complex (NAC), and the skin envelope of the breast is selectively expanded (contoured) with subcutaneously emplaced body-fat, immediately beneath the skin. Such controlled contouring selectively increased the proportional volume of the breast in relation to the size of the nipple-areola complex, and thus created a breast of natural form and appearance; greater verisimilitude than is achieved solely with breast implants. The fat-corrected, breast-implant deformities, were inadequate soft-tissue coverage of the implant(s) and [[capsular contracture]], achieved with subcutaneous fat-grafts that hid the implant-device edges and wrinkles, and decreased the palpability of the underlying breast implant. Furthermore, grafting autologous fat around the breast implant can result in softening the breast capsule.<ref>Rigotti G, Marchi A, Galiè M. et al. Clinical Treatment of Radiotherapy Tissue Damages by Lipoaspirates Transplant: a Healing Process Mediated by Adipose-derived stem cells (ASCS). Plastic and Reconstructive Surgery (accepted for publication).</ref>