Autologous Fat Grafting to the Breast Using REVOLVE System to Reduce Clinical Costs.

BACKGROUND: With the increasing popularity of fat grafting over the past decade, the techniques for harvest, processing and preparation, and transfer of the fat cells have evolved to improve efficiency and consistency. The REVOLVE System is a fat processing device used in autologous fat grafting which eliminates much of the specialized equipment as well as the labor intensive and time consuming efforts of the original Coleman technique of fat processing. This retrospective study evaluates the economics of fat grafting, comparing traditional Coleman processing to the REVOLVE System. METHODS: From June 2013 through December 2013, 88 fat grafting cases by a single-surgeon were reviewed. Timed procedures using either the REVOLVE System or Coleman technique were extracted from the group. Data including fat grafting procedure time, harvested volume, harvest and recipient sites, and concurrent procedures were gathered. Cost and utilization assessments were performed comparing the economics between the groups using standard values of operating room costs provided by the study hospital. RESULTS: Thirty-seven patients with timed procedures were identified, 13 of which were Coleman technique patients and twenty-four (24) were REVOLVE System patients. The average rate of fat transfer was 1.77 mL/minute for the Coleman technique and 4.69 mL/minute for the REVOLVE System, which was a statistically significant difference (P < 0.0001) between the 2 groups. Cost analysis comparing the REVOLVE System and Coleman techniques demonstrates a dramatic divergence in the price per mL of transferred fat at 75 mL when using the previously calculated rates for each group. CONCLUSIONS: This single surgeon's experience with the REVOLVE System for fat processing establishes economic support for its use in specific high-volume fat grafting cases. Cost analysis comparing the REVOLVE System and Coleman techniques suggests that in cases of planned fat transfer of 75 mL or more, using the REVOLVE System for fat processing is more economically beneficial. This study may serve as a guide to plastic surgeons in deciding which cases might be appropriate for the use of the REVOLVE System and is the first report comparing economics of fat grafting with the traditional Coleman technique and the REVOLVE System.

Classification and management of seromas in immediate breast reconstruction using the tissue expander and acellular dermal matrix technique.

Tissue expander (TE)/acellular dermal matrix (ADM)-based breast reconstruction used in immediate postmastectomy breast reconstruction, although a popular technique, is not without complications.Although seroma formation is recognized and reported in the literature as a complication, little information addresses seroma(s) management. We conducted a retrospective review of 100 consecutive TE/ADM immediate reconstructions during a 2-year period, performed by a single surgeon. Data collection included patient demographics, adjuvant therapy, initial TE fill volume, time to completion of expansion, seroma formation, management of seroma, and wound complications, up to the time of definitive implant exchange. From December 2009 to December 2011, 67 patients (100 reconstructions) underwent TE/ADM immediate breast reconstruction. Thirty-one reconstructions were identified having clinically significant seroma(s). Eighteen of the reconstructions required multiple drainage procedures. With these data, a 3-group classification system was created based on the number of aspirations. In review of the 3 groups, 71% of group III required either Seroma-Cath or operative drainage beyond simple aspiration(s). Of the 100 reconstructions, 3 (3%) ended in TE explantation. Only 1 (3%) TE explantation, interestingly from group I, was attributable to seroma formation. Using the data, we devised a management strategy emphasizing attentiveness to seroma formation, recognition, and treatment. Seroma formation is a known entity linked to complications in TE/ADM reconstructive course. A seroma classification system and treatment algorithm is offered to minimize abandonment of the reconstruction and optimize outcomes.