Alexander D. Shapeton¹, Michael Semenovski², Daniel Del Vecchio³

Show more
¹ Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, USA.
² Department of Anesthesiology & Pain Medicine, St. Elizabeth’s Medical Center, Boston, USA.
³ Department of Surgery, St. Elizabeth’s Medical Center, Brighton, USA.
Show less

Abstract: Objective: Autologous fat-grafting for the purpose of breast augmentation has gained widespread acceptance as a viable and safe alternative to classical breast implant procedures and has recently been successfully applied to buttock augmentation. Due to the numerous patient re-positionings and widely variable OR time, these procedures present unique challenges for anesthesiologists. Our goal is to discuss the current surgical methods, anesthetic methods, risks and benefits of this procedure. Methods: This is a retrospective cohort study in the setting of the operating room. Twenty-nine consecutive cases of mega-volume fat transplantation, defined as >300 cc to an individual site, performed by one surgeon, were reviewed. Age, Body Mass Index, total fat injected, total operating room time, maximum intraoperative temperature, minimum intraoperative and temperature were measured. RESULTS: Our procedure has enjoyed a 100% patient satisfaction rate. Analysis reveals high variability in age (21 - 57), total fat injected (200 cc - 1990 cc), patient Body Mass Index (18.8 - 42.2) and total operating room time (1:23:00 - 6:14:00) for our procedures. There were no instances of major complications in this cohort. Conclusions: Autologous fat transplantation for the purposes of breast and buttock augmentation is an emerging technique that shows great promise and high patient satisfaction, but providing unique challenges for anesthesiologists and surgeons.

Keywords: Breast Augmentation, Buttock Augmentation, Tumescent, Clinical Anesthesia, Plastic Surgery, Lipografting, Fat Transplantation

Cite this paper: Shapeton, A. , Semenovski, M. and Vecchio, D. (2014) Mega-Volume Fat Transplantation to the Breast and Buttocks: A New Surgical Technique That Brings New Anesthetic Challenges. Open Journal of Anesthesiology, 4, 254-262. doi: 10.4236/ojanes.2014.410038.

References

[1]   American Society of Plastic Surgeons (2012) American Society of Plastic Surgeons Report of the 2010 Plastic Surgery Statistics.
www.plasticsurgery.org

[2]   Gutowski, K.A. (2009) Current Applications and Safety of Autologous Fat Grafts: A Report of the ASPS Fat Graft Task Force. Plastic and Reconstructive Surgery, 124, 272-280.
http://dx.doi.org/10.1097/PRS.0b013e3181a09506

[3]   Nicareta, B., Pereira, L.H., Sterodimas, A. and Illouz, Y.G. (2011) Autologous Gluteal Lipograft. Aesthetic Plastic Surgery, 35, 216-224.
http://dx.doi.org/10.1007/s00266-010-9590-y

[4]   Rosing, J.H., Wong, G., Wong, M.S., Sahar, D., Stevenson, T.R. and Pu, L.L. (2011) Autologous Fat Grafting for Primary Breast Augmentation: A Systematic Review. Aesthetic Plastic Surgery, 35, 882-890.
http://dx.doi.org/10.1007/s00266-011-9691-2

[5]   Blanchard, J. (2011) Humidity, Temperatures, and Air Exchanges in the OR [Clinical Issues]. AORN Journal, 89, 1129-1131.
http://dx.doi.org/10.1016/j.aorn.2009.05.012

[6]   Fuzaylov, G. and Fidkowski, C.W. (2009) Anesthetic Considerations for Major Burn Injury Pediatric Patients. Pediatric Anesthesia, 19, 202-211.
http://dx.doi.org/10.1111/j.1460-9592.2009.02924.x

[7]   Klock Jr., P.A., Czeslick, E.G., Klafta, J.M., Ovassapian, A. and Moss, J. (2001) The Effect of Sevoflurane and Desflurane on Upper Airway Reactivity. Anesthesiology, 94, 963-967.
http://dx.doi.org/10.1097/00000542-200106000-00008

[8]   Rüsch, D., Eberhart, L.H., Wallenborn, J. and Kranke, P. (2010) Nausea and Vomiting after Surgery Under General Anesthesia an Evidence-Based Review Concerning Risk Assessment, Prevention, and Treatment. Deutsches Ärzteblatt International, 107, 733-741.

[9]   Gan, T.J., Meyer, T.A., Apfel, C.C., Chung, F., Davis, P.J., Habib, A.S., Hooper, V.D., et al. (2007) Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting. Anesthesia and Analgesia, 105, 1615-1628.
http://dx.doi.org/10.1213/01.ane.0000295230.55439.f4

[10]   Steely, R.L., Collins Jr., D.R., Cohen, B.E. and Bass, K. (2004) Postoperative Nausea and Vomiting in the Plastic Surgery Patient. Aesthetic Plastic Surgery, 28, 29-32.
http://dx.doi.org/10.1007/s00266-004-3015-8

[11]   Punjasawadong, Y., Boonjeungmonkol, N. and Pongchiewboon, A. (2007) Bispectral Index for Improving Anaesthetic Delivery and Postoperative Recovery. Cochrane Database Systematic Reviews, 17, Published Online.

[12]   Klein, J.A. (1988) Anesthesia for Liposuction in Dermatologic Surgery. The Journal of Dermatologic Surgery and Oncology, 14, 1124-1132.
http://dx.doi.org/10.1111/j.1524-4725.1988.tb03469.x

[13]   Grazer, F.M. and de Jong, R.H. (2000) Fatal Outcomes from Liposuction: Census Survey of Cosmetic Surgeons. Plastic & Reconstructive Surgery, 105, 436-446.

[14]   Mehra, P., Caiazzo, A. and Maloney, P. (1998) Lidocaine Toxicity. AnesthProg, 45, 38-41.

[15]   Klein, J.A. (1990) Tumescent Technique for Regional Anesthesia Permits Doses of 35 mg/kg for Liposuction. The Journal of Dermatologic Surgery and Oncology, 16, 248-263.
http://dx.doi.org/10.1111/j.1524-4725.1990.tb03961.x

[16]   Ostad, A., Kageyamam, N. and Moy, R.L. (1996) Tumescent Anesthesia with Lidocaine Dose of 55 mg/kg Is Safe for Liposuction. Journal of Dermatologic Surgery & Oncology, 22, 921-927.

[17]   Weinberg, G.L. (2012) Lipid Emulsion Infusion: Resuscitation for Local Anesthetic and Other Drug Overdose. Ansthesiology, 117, 180-187.
http://dx.doi.org/10.1097/ALN.0b013e31825ad8de

[18]   Dix, S.K., Rosner, G.F., Nayar, M., Harris, J.J., Guglin, M.E., Winterfield, J.R., Xiong, Z., et al. (2011) Intractable Cardiac Arrest Due to Lidocaine Toxicity Successfully Resuscitated with Lipid Emulsion. Critical Care Medicine, 39, 872-874.
http://dx.doi.org/10.1097/CCM.0b013e318208eddf

[19]   Neal, J.M., Bernards, C.M., Butterworth, J.F., Di Gregorio, G., Drasner, K., Hejtmanek, M.R., Mulroy, M.F., et al. (2010) ASRA Practice Advisory on Local Anesthetic Systemic Toxicity. Regional Anesthesia & Pain Medicine, 35, 152-161.
http://dx.doi.org/10.1097/AAP.0b013e3181d22fcd

[20]   Martínez, M.A., Ballesteros, S., Segura, L.J. and García, M. (2008) Reporting a Fatality during Tumescent Liposuction. Forensic Science International, 178, e11-e16.
http://dx.doi.org/10.1016/j.forsciint.2008.01.013

[21]   Nishikawa, K., Kokita, N., Koshimizu, S., Itoh, T., Ichimiya, T. and Namiki, A. (1995) Cardiopulmonary Resuscitation with Continuous Veno-Venous Hemofiltration for Intraoperative Cardiac Arrest Owing to Hypothermia—A Case Report. Masui, 44, 1401-1405.

[22]   Mattei, A., Di Pierro, G.B., Rafeld, V., Konrad, C., Beutler, J. and Danuser, H. (2013) Positioning Injury, Rhabdomyolysis and Serum Creatinine Kinase-Concentration Course in Patients Undergoing Robot-Assisted Radical Prostatectomy and Extended Pelvic Lymph Node Dissection. Journal of Endourology, 27, 45-51.
http://online.liebertpub.com/doi/abs/10.1089/end.2012.0169
http://dx.doi.org/10.1089/end.2012.0169

[23]   Pillai, A.K., Ferral, H., Desai, S., Paruchuri, S., Asselmeier, S. and Perez-Gautrin, R. (2007) Brachial Plexus Injury Related to Patient Positioning. Journal of Vascular and Interventional Radiology, 18, 833-834.
http://dx.doi.org/10.1016/j.jvir.2007.04.033

[24]   Wang, H.D., Zheng, J.H., Deng, C.L., Liu, Q.Y. and Yang, S.L. (2008) Fat Embolism Syndromes Following Liposuction. Aesthetic Plastic Surgery, 32, 731-736.
http://dx.doi.org/10.1007/s00266-008-9183-1

[25]   Gurd, A.R. and Wilson, R.E. (1974) The FES. The Journal of Bone & Joint Surgery, 56, 408-416.

[26]   Laub Jr., D.R. and Laub, D.R. (1990) Fat Embolism Syndrome after Liposuction: A Case Report and Review of the Literature. Annals of Plastic Surger, 25, 48-52.
http://dx.doi.org/10.1097/00000637-199007000-00011

[27]   Shaikh, N. (2009) Emergency Management of Fat Embolism Syndrome. Journal of Emergencies Trauma and Shock, 2, 29-33.
http://dx.doi.org/10.4103/0974-2700.44680

[28]   Enneking, F.K. (1995) Cardiac Arrest during Total Knee Replacement. Journal of Clinical Anesthesia, 7, 253-263.
http://dx.doi.org/10.1016/0952-8180(94)00043-4

[29]   Sarkar, S., Mandal, K. and Bhattacharya, P. (2008) Successful Management of Massive Intraoperative Pulmonary Fat Embolism with Percutaneous Cardiopulmonary Support. Indian Journal of Critical Care Medicine, 12, 136-139.
http://dx.doi.org/10.4103/0972-5229.43684

[30]   Fulde, G.W. and Harrison, P. (1991) Fat Embolism—A Review. Archives of Emergency Medicine, 8, 233-239.
http://dx.doi.org/10.1136/emj.8.4.233