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HaHandchirurgie

Mikrochirurgie
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Plastische Chirurgie
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December 2010 · Volume 42 · Page 379–385 www.thieme-connect.de/ejournals
Reprint

BEAULI™ –
A New and Easy Method
for Large-Volume Fat Grafts

K. Ueberreiter, J. G. von Finckenstein, F. Cromme,


C. Herold, U. Tanzella, P. M. Vogt

Publisher and Copyright:


© 2010 by
Georg Thieme Verlag KG
Rüdigerstraße 14
D-70469 Stuttgart
ISSN 0722-1819

Reprint with the permission


of the publishers only

h
Original Article 379

BEAULI™ – A New and Easy Method for Large-Volume


Fat Grafts
BEAULI™ – eine neue Methode zur einfachen und zuverlässigen Fettzell-
Transplantation

Authors K. Ueberreiter1, J. G. von Finckenstein2, F. Cromme3, C. Herold4, U. Tanzella3, P. M. Vogt5

Affiliations Affiliation addresses are listed at the end of the article

Key words Abstract Zusammenfassung


●▶ breast supplementation ▼ ▼
●▶ autologous fat grafts
After numerous experiments with free-fat trans- Nach vielzähligen Versuchen in der freien Ver-
●▶ breast reconstruction
fer since 1893 [1], many promising methods pflanzung von körpereigenemn autologem Fett-
●▶ BEAULI
and results of large-volume fat grafts have been gewebe seit 1893 [1] besteht in den letzten Jah-
●▶ liposuctions
published recently [2–6]. A common disadvan- ren aufgrund zahlreicher Publikationen zu dem
Schlüsselwörter tage was the time of the procedure and a lack of Thema sowie der Entwicklung neuer Techniken
●▶ Mammaaugmentation proof of efficiency. In 2007 we developed with ein hohes Interesse an dieser Erweiterung des
●▶ Fettzell-Transplantation the BEAULI™ method (Berlin autologous lipo- plastisch chirurgischen Behandlungsspektrums.
●▶ Mammarekonstruktion transplantation) a new and reliable procedure Gleichzeitig fehlte ein Verfahren zur Gewinnung
●▶ BEAULI
to collect larger amounts of transplantable fatty und Verpflanzung größerer Volumina in kurzer
●▶ Liposuction
tissue. It was evaluated in a prospective clinical Zeit. Ein solches neues Verfahren zur einfachen
study with 85 patients in 2 centres in Germany, und zuverlässigen Gewinnung größerer trans-
the overall number of transplantations amount- plantabler Fettmengen Verfahren steht seit Ok-
ing to 216 treated breasts. Indications were gen- tober 2007 mit der BEAULI™ (Berlin Autologous
eral lack of breast volume, either genuine or ac- Lipotransfer) Methode zur Verfügung. In einer
quired in the course of surgical procedures. The prospektiven klinischen Studie wurden seit Ok-
fat was harvested with the BEAULI™ method, tober 2007 in 2 Zentren in Deutschland 85 Pa-
which consists in general of the harvest of very tientinnen mit Gewebedefizit im Bereich der
small fat particles by means of water-assisted Brust durch Eigenfetttransplantation behandelt.
liposuction (body-jet®, human med AG, Ger- Die Summe aller Transplantationen (Behandlung
many) and reinjection of the fat after separation jeweils einer Brust) lag Ende April bei 216. Das
from superfluous water by means of the Lipo- Fett wurde dabei durch die BEAULI™ Metho-
Collector®. All procedures were performed in a de gewonnen. Diese basiert auf der Gewinnung
submitted 27.5.2010 standardised pattern, measurements were taken kleinster Fettpartikel mittels Wasserstrahl assis-
accepted 28.9.2010 preoperatively, at day 1 postop, after 1 week, 4 tierter Liposuction (mit dem „body-jet®“ der Fa.
weeks, 3 months, 6 months and then to be con- human med AG, Schwerin) und anschließender
Bibliography tinued yearly. An MRI of the breasts was taken Separierung des Fettanteiles mit dem LipoCol-
DOI http://dx.doi.org/ preop and 6 months postoperatively, the longest lector®. Die Operationen wurden standardisiert
10.1055/s-0030-1267913
follow-up is 30 months. Operation time was (on durchgeführt, präoperativ sowie 6 Monate post-
Handchir Mikrochir Plast Chir
average) 1.5 h. In every case a definite increase of operativ wurde ein MRT der Mamma angelegt
2010; 42: 379–385
© Georg Thieme Verlag KG the volume of the fatty layer in the treated areas sowie klinische Kontrolluntersuchungen präop,
Stuttgart · New York was observed. We saw no macroscopic oily cysts, an Tag 1 postop, nach 1 Woche, 4 Wochen, 3 Mo-
ISSN 0722-1819 in 2 cases there were 3 months after the opera- naten und 6 Monaten. Nach Möglichkeit schlie-
tion some palpable subcutaneous nodules which ßen sich Nachbeobachtungen im Jahresrhyth-
Correspondence proved to be granulomas. The volume control mus an. Der längste Beobachtungszeitraum liegt
Dr. Klaus Ueberreiter of 35 aesthetic patients by means of BrainLab™ derzeit bei 30 Monaten. Die durchschnittliche
Asklepios Klinik Birkenwerder
Software and MRI could verify a permanent take OP Dauer betrug 1,5 Stunden. Bei allen Patienten
Division for Plastic and
rate of 76 ± 11 % of the grafted fat. In aesthetic pa- kam es zu einer deutlichen Vermehrung des sub-
Aesthetic Surgery
Hubertusstraße 12–22 tients generally 2 (80 %) fat-grafting procedures kutanen Fettgewebes. Der gemessene Zugewinn
16547 Birkenwerder with an average gain in volume of 1/2 bra cup lag bei 76 ± 11 % des transplantierten Fettes nach
k.ueberreiter@asklepios.com size or 100–150 mL) per procedure were re- volumetrischer Auswertung der MRT Bilder von

Ueberreiter K et al. BEAULI™ – A New and Easy Method … Handchir Mikrochir Plast Chir 2010; 42: 379–385
380 Original Article

quired. After implant removal, satisfaction was usually reached 35 Patientinnen. Bei Entfernungen von Silikonimplantate nach
after only a single procedure, for complete reconstruction after Kapselfibrose wurde von den Patienten in der Regel nicht mehr
cancer surgery 4–5 grafting sessions were necessary. An exten- als eine Fetttransplantation gewünscht, obwohl die transplan-
sion of the skin envelope as well as improvement of existing tierten Mengen zum Teil deutlich unter Volumina der ent-
scars were observed. fernten Silikonimplantate lagen. Im ästhetischen Bereich lag der
Schnitt bei 2 Transplantationen, womit etwa eine Körbchen-
größe gewonnen werden konnte (d. h. etwa ½ Körbchen bzw.
100–150 ml) je Transplantation). Für einen kompletten Wie-
deraufbau der Brust nach Ablatio sind 4–5 Transplantationen
erforderlich. Eine weitere Beobachtung lag in der starken Ver-
besserung der Narbenqualität und einer kontinuierlichen Auf-
dehnung des Hautmantels.

Introduction Since 2005 we have been conducting water-jet assisted liposuc-


▼ tion (WAL) and made the harvested fat available for fat cell re-
100 years have elapsed since the first published description of search in the Franz Vollhardt Clinic of Charité Hospital, Berlin.
an adipose tissue transplantation by Neuber [1] and of a partial The harvest of vital cells was found comparable to that under the
breast reconstruction through injection of autologous adipose Coleman technique. A vessel for the sterile separation of the adi-
tissue by Holländer [2]. Following a series of publications during pose tissue from the tumescence solution was developed in
the pre-World War II period [3–6] the topic receded almost to 2007 through a series of tests in collaboration with human med
being forgotten. An outstanding exception in the subsequent AG, Schwerin, which is now being marketed under the name Li-
years is the study by Peer [7]. Only after liposuction was intro- poCollector™. The method was termed simply BEAULI (Berlin
duced by Fischer and in particular by Illouz [8] did adipose tis- Autologous Lipotransfer) to enable future international compa-
sue transplantation come into vogue [9–12]. However, in 1987 rison of the different methods on the market.
an ASRPS “Ad Hoc Committee on New Procedures” rejected fat
transplantation in the breast without a basis of evidence [13].
This position has only recently been revised [14]. Selection of Patients
There was a strong upswing in scientific investigation of the sub- ▼
ject with the publication of research by von Chajchir [15, 16], Non-smoking patients with a BMI between 20 and 30 were in-
Coleman [17–19], Delay [20, 21], Rigotti [22, 23]. More recently, cluded. All patients desired improvement in breast size and at
numerous groups of researchers in different countries have ex- the same time refused to undergo a conventional breast aug-
perimented with autologous fat transplantation in the breast. In mentation procedure. They received a detailed explanation of
Germany, one of such groups is the DGPRAEC [24]. All previous the possible risk of formation of oil cysts and calcifications.
methods have encountered a severe limitation – the duration of
the operation itself. The original technique (LipoStructure) used
by Coleman [19] in aesthetic bilateral breast enlargement took Method
at least 5–7 h. Other approaches are associated with rather high ▼
costs (BRAVA), have sometimes had only a low rate of fat integra- First, all patients were measured for height, weight, jugulum-
tion, or provide no real proof of an effective integration rate. mamilla distance (JMD) and maximum circumference of each
Another currently discussed question is supplemental tissue breast, measured from the medial to the lateral attachment;
grafting with fat stem cells (ADSC) [25]. These cells are isolated standardised photo documentation (mirror image) was added.
from the adipose tissue through enzymatic digestion and me- All data were collected on a specific questionnaire.
chanically, and later added to the fatty graft tissue. The integra- Data on the areas suctioned, the amount of graft used, distribu-
tion rate is improved through greater angioneogenesis. However, tion subcutaneously or in the pectoral muscle, and the results of
this hypothesis still lacks evidence-based proof. Furthermore, centrifugation were recorded in a separate operative protocol.
the duration of the fat cell transplantation procedure is consi- The postoperative data (height, weight, measurement for the
derably lengthened (by at least 2 h) and costs are significantly JMD, maximum circumference of each breast – measured from
raised. Its wide clinical use does not currently seem to be feasi- the level of the anterior axillary line over the mamilla to the me-
ble. dial attachment – and postoperative pain scale) were recorded
Whenever a rather large portion of the transplanted fat is discar- on the day following the operation, after 1 week, 1 month, 3
ded because of poor perfusion (tissue clumping), it should be months, and 6 months.
noted that not all the necrotic cells are carried off by macro- Liposuction was performed on the day of the operation, prefe-
phages, but undergo a confluence into oil cysts through the lack rably from areas of the abdomen and flanks and on the outside
of contact with well perfused tissue following autolysis of the and inside of the thighs. The area for harvesting was selected
cell membrane, and then can become calcified, as several pu- according to the wishes of the patients. The area to be suctioned
blications have described [26]. was first infiltrated with the body-jet® using a Klein standard
The objective of this research therefore was to develop a technique tumescence solution (composition: 500 mg lidocaine, 1 mg adre-
for cell-friendly harvesting of fat cell particles which would consi- nalin and 12.5 ml sodium bicarbonate 8.4 % in a 1 l solution) [27]
derably reduce operation time and concomitantly result in a high and liposuction was started without a waiting period. Infiltra-
integration rate among the transplanted fat cells. tion and liposuction were performed with the same solution.
The solution was warmed to 35 ° to prevent excessively rapid

Ueberreiter K et al. BEAULI™ – A New and Easy Method … Handchir Mikrochir Plast Chir 2010; 42: 379–385
Original Article 381

cooling and consequent damage to the fat cells. Furthermore, it Results


is more pleasant for subjects if several litres of cold solution are ▼
not also chilling their bodies. Between 1 October, 2007 and 31 March, 2010 a total of 85 pa-
The liposuction procedure involved the application of a pulsing tients were treated with autologous fat grafts for breast aug-
water jet on the body-jet® device – with the setting at Level 1 – mentation with this method (● ▶ Table 1). The indications were a

and constant irrigation with the tumescence solution and nega- desire for aesthetic enlargement, reconstruction after partial or
tive pressure, which was limited to − 0.5 bar. The pressure limi- total mastectomy, or capsular fibrosis after silicone implants in
tation was selected after pilot studies following centrifugation of combination with refusal of implants.
the aspirate indicated that the proportion of clear oil increased 36 patients who had undergone aesthetic augmentation were
in step with a rise in suction pressure. Suction pressure less evaluated for volume on MRI since they presented too many in-
than − 0.5 bar led to frequent blockage of the suction channel dividual factors after implant removal or reconstruction.
and much less efficiency in fat harvesting. The cannula used was Analysis of the clinical follow-up record gave the following re-
the 3.8 mm body-jet® Rapid cannula with effective suction aper- sults: mean operation time (incision-to-suturing): 92 min with a
tures of 0.9 mm. These narrow apertures enable harvesting of significantly declining trend. Currently, the operation time
equally small fat cell structures which also integrate well. stands at approximately 1 h.
The same step included the separation of the fat in the LipoColl- The postoperative course of the jugulum-mamilla distance is
ector™ from the aqueous elements (● ▶ Fig. 1) so that the amount shown in ● ▶ Table 2. The mean increase is about 1 cm or 7 %

of residual fluid in the mixture was equivalent to that after (●▶ Table 2).

10 min decanting. ●▶ Table 3 shows the change in single breast circumference over

The LipoCollector™ basically consists of a prefilter to remove fi- the assessment period. The mean increase is about 1.7 cm or
brous elements which could choke the thin injection cannulas. 9.2 % (●
▶ Table 3).

The fat flushed out by continual irrigation is separated from the The development of breast circumference over an assessment
excess fluid by means of a sieve in the LipoCollector. period of 6 months is shown in ● ▶ Fig. 3. It appears that mea-

The fluid is then suctioned off and the separated washed fat re- surement of the particular circumference of each breast from
mains sterile on the operating table for later use. the anterior axillary line to the medial attachment over the
An average of 60 min was needed (including prefiltration) to
harvest 600 ml of transplantable clear adipose tissue.
The harvested fat was then suctioned from the container with the
BEAULI™ extraction cannula and 50 cm3 syringes. These are left
upright for 10 min in a stand on the table and fluid settling at the
base is removed in 10 cm3 syringes before transfer. Direct reinjec-
tion from the 10 cm3 syringes utilises BEAULI injection cannulas.
Reinjection is made via a small, approx. 5 cm, laterocaudal stab
incision of the breast. All segments of the breast are accessible
from the incision because of the length of the cannula. Fat infil-
tration is performed exclusively in the area of the subcutaneous
adipose tissue and the pectoral muscle. The adipose tissue is usu-
ally distributed so that about two-thirds is placed in the area of
subcutaneous fat and about one-third intrapectorally. The pec-
toral muscle was probed by palpating bluntly against the nearest
rib with the cannula and then performing the injection directly
above the ribs while maintaining constant contact with them. Fig. 1 LipoCollector (diagram).
Care was taken during distribution of the fat to ensure that the
tissue was not subjected to excessive tension, to avoid applica-
tion of additional pressure around the fat cells. The individually Fig. 2 Centrifuged
grafted (net) fat amount ranged between 120 cm3 and 292.5 cm3 material.

with a mean of 184.4 cm3.


To calculate the exact volume obtained through fat transplanta-
tion, two 10 cm3 syringes from the graft series were centrifuged
at 3 000 rpm for 3 min. The readable proportions of free oil
and clear fluid were then recorded in the operative protocol
(●▶ Fig. 2). The proportion of clear grafted fat ( = net fat percen-

tage) was used as the basis for volume assessment.


The postoperative follow-up involved the administration of an
oral antibiotic for 3 days. A cotton pad was applied for 2 days to
avoid pressure on the breast and to cool the tissue. A compres-
sion brace was placed on the graft harvesting areas. Wearing of
a compression bra and avoidance of physical exertion were not
necessary.

Ueberreiter K et al. BEAULI™ – A New and Easy Method … Handchir Mikrochir Plast Chir 2010; 42: 379–385
382 Original Article

largest circumference does not in fact represent an exact measur- Discussion


ing criterion, but overall it gives a good indicator of the resorp- ▼
tion behaviour of the fat. Similar development can be seen in the In the 100 plus years that have elapsed since the first published
jugulum-mamilla distance (● ▶ Fig. 4). The measurements corre- description of a free adipose tissue graft in the breast and in
late with the clinical observation that no further volume loss many years of post-procedure observation [17, 20, 30, 31] no sig-
occurs after postoperative month 3. We are therefore able to nificant negative effects, especially possible cancer occurrences,
provide future patients with more precise information on the have been reported [32]. Ever since the basic possibility of per-
course to be expected. forming adipose tissue transplantation has stopped being chal-
The course of pain sensitivity over the assessment period is lenged, the foremost question has been that of completing the
shown in ● ▶ Table 4. Significant haematoma formation in the intervention within an acceptable period of time. Important fac-
breast area was not found. Pain was predominantly localised to tors for success include a tissue-friendly procedure, a low suc-
the graft harvesting area. tion level, and the distribution of the smallest adipose tissue
The mean content of pure fat obtained after centrifugation at particles in a well perfused recipient site [1, 19, 33]. The Lipo-
3 000 rpm for 3 min stayed very constant at 68 % (range 60–72 %). Structure™ method pioneered by Coleman meets these require-
ments, but is very time-consuming when the amount of grafting
Volumetric Assessment to be done is large.
Regarding the MRI assessment of volume, we refer to the article We have shown that with the water-jet assisted Liposuction
by Herold in the same journal [28]. MRI seems to be the current- (WAL) all these requirements can be met – and this in a much
ly superior method for the provision of real-time proof of struc- shorter time.
tural changes, cost benefit, and precision of results even though 1. Through continual irrigation with water liposuction becomes
calculations of volume are also possible by photographic me- possible with very small apertures (0.9 ml/millimetre) and
thods [29]. low suction pressure (0.5 bar).
The examinations were performed with T1 weighting in the bre- 2. Centrifugation of the harvested fat can be omitted since the
ast coil. The first examination was preoperative (● ▶ Fig. 5a), the mean residue of 30 % fluid permits easy reinjection with
second came 6 months after the grafting procedure (● ▶ Fig. 5b). 10 cm3 syringes and leads to a uniform distribution of the fat
A comparison of 72 MRI scans performed at least 6 months after in the tissue.
the intervention showed a mean adipose tissue integration rate 3. The mean duration of the intervention at 92 min for a bilate-
of 76 ± 11 %. ral breast enlargement is not significantly longer than the
Therefore, the mean net increase in breast volume was equiva-
lent to approximately 50 % of the injected gross volume (68 % fat
content × 76 % integration rate ≈50 %). This represents an actual Course of single breast circumference after operation
17.5
Circumference of single breast (cm)

mean gain in volume of 100–120 ml from each graft procedure.

17

16.5
Table 1 Patients.

Patients Procedures MRI 6 MRI 12 16


months months
reconstruction 21 41 1 15.5
aesthetics 52 152 36 8
capsular fibrosis 12 23 6 15
0 20 40 60 80 100 120 140 160 180
total 85 216 43 Days

Fig. 3 Development of breast circumference over 6 months.

Table 2 Change in jugulum-mamilla distance over the assessment period.

Time of Pre- Day 1 Week 1 Week 4 Month 3 Month 6 Course of jugulum-mamilla distance (JMD)
measure- operative postop. postop. postop. postop. postop. 22
ment
21.5
distance 19.02 21.78 21.72 21.22 20.80 20.77
(cm) 21
JMD (Mean, cm)

20.5

20
Table 3 Change in single breast circumference over the assessment period
19.5
(mean, in cm).
19
Time of Pre- Day 1 Week 1 Week 4 Month 3 Month 6
measure- operative postop. postop. postop. postop. postop. 18.5
0 20 40 60 80 100 120 140 160 180
ment Days
distance 14.4 16.2 16.4 15.8 15.4 15.4
(cm) Fig. 4 Mean development of the jugulum-mamilla distance.

Ueberreiter K et al. BEAULI™ – A New and Easy Method … Handchir Mikrochir Plast Chir 2010; 42: 379–385
Original Article 383

time for conventional enlargements with implants. In this the breast circumference and the jugulum-mamilla distance is
case, the liposuction associated with the intervention must indeed inexact in individual cases and subject to fluctuation ac-
be considered a separate procedure. cording to researcher, but a comparison of mean values clearly
Nearly all interventions were performed on an outpatient basis demonstrates significant trends over the postoperative course
and under local anaesthesia with sedation (remifentanil). which correlate well with the clinical picture and permit us to
In the postoperative course only minor symptoms in the breast take a position on the postoperative outcome. Further resorp-
area were reported; in individual cases there was some signifi- tion beyond month 3 clearly did not occur.
cant haematoma formation. The intervention was so low in Infections were not observed at all; 2 patients presented subcu-
stress for the patients that most (over 80 %) decided on a second taneous granulomas (histologically confirmed), which did not
fat cell transplantation. The very simple measuring method for require any special treatment. Macroscopically detectable oil
cysts were not observed on the MRI, and palpation explorations
Table 4 Course of pain sensitivity over the assessment period (visual analo- were unremarkable except in 2 patients with subcutaneous gra-
gue scale 0–10). nuloma formation (histologically confirmed).
Time of Pre- Day 1 Week 1 Week 4 Month 3 Month 6
Since the thickness of subcutaneous adipose tissue is individual-
ly very variable and often hardly detectable in patients with
measure- operative postop. postop. postop. postop. postop.
very small breasts, only a small volume amount could be intro-
ment
duced at the first augmentation (approx. 200–250 ml gross incl.
analogue 0 3 2 0 0 0
residual fluid from the tumescence solution). We basically deci-
scale
1–10
ded therefore to implant fat cells in the subcutaneous and intra-
muscular areas exclusively. This was based on 2 fundamental
considerations:
1. Even in tissue-friendly grafting of very small particles the for-
mation of oil cysts or calcifications cannot be definitively ex-
cluded. With the use of (digital) mammography or MRI such
changes can now be easily distinguished from malignant
changes. This distinction is also further enabled if the aetiolo-
gy can be traced on the basis of the tissue layer in which they
are detected.
2. In terms of survival – quoad vitam – 1 woman in 10 today is
faced with the risk of developing breast cancer. Since we all
possess a strong tendency to create associations (even those
non-existent medically), we should assume that in the case of
patients treated with autologous fat some will develop breast
cancer in later life. This originates, however, in the glands and
therefore outside the subcutaneous adipose tissue. It seems
safer, especially in the case of a new method, to cut off at the
outset any false conclusions relating to a prior operative in-
Fig. 5 a, b MRI before and 6 months after lipotransfer of 180 ml (right)
tervention. Furthermore, autologous fat transplantation after
and 210 ml (left) (gross amounts).
breast cancer is more acceptable than in the case of a primary

Fig. 6 Situation 1 year after the last intervention


with a 2-stage graft of 220 and 240 ml gross (150
and 165 ml net) respectively in the space of 6
months.

Ueberreiter K et al. BEAULI™ – A New and Easy Method … Handchir Mikrochir Plast Chir 2010; 42: 379–385
384 Original Article

Fig. 7 Breast reconstruction with 4 grafts 6


months after the last intervention.

augmentation. In our current state of data, an increased risk Conflict of Interest: None
of cancer through fat transplantation is not supported [32].
3. The pectoral muscle is much more porous in structure and
easily absorbs 50 ml adipose tissue in a session. It also enables
Klaus Ueberreiter
a better projection. Intramuscular distribution of the fat im-
Born in Berlin on 20 July, 1955. 1975–
mediately above the ribs is achievable via the lateral caudal
1976: Development project volunteer in
incision with use of the long injection cannula.
Rhodesia/ Zimbabwe; here he decided to
In the case of augmentation with an aesthetic indication only,
pursue a career in Medicine. 1976–1983:
usually 2 grafts (85 % of subjects) and in only a few cases 3 inter-
Medical studies at the Free University of
ventions were desired. Since a net mean volume increase per
Berlin. Study for medical licence 1982 to
graft of 125 ml (1/2 cup size) is attainable, the volume increase
1983 in Berlin and Comarapa (Bolivia); doctoral thesis title:
obtained matches that of an implant. 1 patient with a very small
Parasitic infestation and general living conditions of school-
breast desired a third graft (●
▶ Fig. 6).
children in a rural area of Bolivia. Conferral of degree with
It was clear from the outset that a satisfactory result would not
magna cum laude. 1983–1985: Residency in the Recovery/
be attainable with a single graft in patients seeking breast re-
Poison Unit in Charlottenburg Hospital, Free University of
construction after mastectomy since the existing layer of tissue
Berlin. 1985–1993: Dept. of Surgery, Dominicus Hospital,
was very small (1–3 cm) to act as a receiving site. In this case,
Consultant in Surgery. 1993–1995: Division of Plastic
3–5 grafts were planned and performed (● ▶ Fig. 7). The repeat
Surgery, Dominicus Hospital. 1995–1997: Member of the
interventions were also well tolerated since these interventions
Continuing Education Committee, Medical Council of Berlin.
are associated with very little morbidity.
1995–1997: Division of Plastic, Hand and Breast Surgery,
In the case of a second or further augmentation a proportionate-
Schlosspark Clinic, Berlin. 1997: Division of Plastic-Hand-
ly greater amount of graft material could be implanted because
Restorative Surgery, Severe Burns and Trauma Centre,
of the now-existing expansion of the receiving site. We will re-
Medical University, Hannover. 1998: Consultant in Plastic
port on this topic in a separate publication.
Surgery. 1998: Head of the Division of Plastic Surgery,
The measurements of breast circumference gave a good idea of
Asklepios Clinic Birkenwerder near Berlin. 1998: European
the course of the postoperative development. The greatest swell-
Board Certified Plastic Surgeon.
ing occurred after 1 week, with relatively rapid regression by
week 4. After 3 months no further changes were observed. The
method is best suited for those patients who are primarily seek- Affiliations
1
ing a moderate increase in breast size, but for whom liposuction Asklepios Klinik Birkenwerder, Abteilung für Plastische und Ästhetische
Chirurgie, Birkenwerder
has its own importance. For patients with a BMI under 18 the 2
Klinikum Starnberg, Abteilung für Plastische und Ästhetische Chirurgie,
method is unsuitable, and likewise if a subject desires the great- Starnberg
3
est possible size from 1 operation (“from A to C”). Asklepios Klinik Birkenwerder, Plastische Chirurgie, Birkenwerder
4
Medical School Hannover, Plastic, Hand- and Reconstructive Surgery,
The potential of the method is very promising in cases of defini-
Hannover
tive implant removal after capsular formation, total or partial 5
Mendizinische Hochschule Hannover, Klinik für Plastische, Hand- und
reconstruction after mastectomy, or in general corrections of Wiederherstellungschirurgie, Zentrum für Schwerbrandverletzte, Hannover
volume deficits; it opens up new horizons in plastic surgery.

Ueberreiter K et al. BEAULI™ – A New and Easy Method … Handchir Mikrochir Plast Chir 2010; 42: 379–385
Original Article 385

References 20 Delay E, Garson S, Tousson G et al. Fat injection to the breast: technique,
1 Neuber G. Über die Wiederanheilung vollständig vom Körper ge- results, and indications based on 880 procedures over 10 years. Aes-
trennter, die ganze Fettschicht enthaltender Hautstücke. In: Zbl f thet Surg J 2009; 29: 360–376
Chirurgie 1893; 30: 16 21 Delay E, Delaporte T, Sinna R. [Breast implant alternatives]. Ann Chir
2 Holländer E. Über einen Fall von fortschreitendem Schwund des Fett- Plast Esthet 2005; 50: 652–672
gewebes und seinen kosmetischen Ersatz durch Menschenfett. In: 22 Rigotti G, Marchi A, Sbarbati A. Adipose-derived mesenchymal stem
Münch Med Wochenschr 1910; 57: 1794–1795 cells: past, present, and future. Aesthetic Plast Surg 2009; 33:
3 Lexer E. Free Transplantation. Ann Surg 1914; 60: 166–194 271–273
4 Wederhake K. Über die Verwendung des menschlichen Fettes in der 23 Rigotti G. Lipoaspirated stem cells may not have been placed in ische-
Chirurgie. In: Berl Klin Wochenschr 1918; 66: 47 mic tissue: reply. Plast Reconstr Surg 2008; 122: 680–681
5 Joseph J. Nasenplastik nebst einem Anhang über Mammaplastik. Ber- 24 Rennekampff HO, Reimers K, Gabka CJ et al. Möglichkeiten und Grenzen
lin 1929 der autologen Fetttransplantation – „Consensus Meeting“ der DGPRAC
6 Lexer E. Die gesamte wiederherstellungschirurgie. 2. aufl. ed. Leipzig,: in Hannover, September 2009. Handchir Mikrochir Plast Chir 2010;
J. A. Barth; 1931; 2 v 42: 137–142
7 Peer L. Loss of weight and volume in human fat graft, with postu- 25 Brayfield C, Marra K, Rubin JP. Adipose stem cells for soft tissue rege-
lation of a “cell survival theory”. In: Plast Reconstr Surg 1950; 5: neration. Handchir Mikrochir Plast Chir 2010; 42: 124–128
217–230 26 Pulagam SR, Poulton T, Mamounas EP. Long-term clinical and radiolo-
8 Illouz YG. Body contouring by lipolysis: a 5-year experience with over gic results with autologous fat transplantation for breast augmenta-
3000 cases. Plast Reconstr Surg 1983; 72: 591–597 tion: case reports and review of the literature. Breast J 2006; 12:
9 Bircoll M. Autologous fat transplantation to the breast. Plast Reconstr 63–65
Surg 1988; 82: 361–362 27 Klein JA. Anesthesia for liposuction in dermatologic surgery. J Derma-
10 Bircoll M. Autologous fat transplantation. Plast Reconstr Surg 1987; tol Surg Oncol 1988; 14: 1124–1132
79: 492–493 28 Herold C, Ueberreiter K, Cromme F et al. MRT-Volumetrie der Mamma
11 Bircoll M. Cosmetic breast augmentation utilizing autologous fat and zur Kontrolle der Fettresorptionsrate nach autologem Lipotransfer.
liposuction techniques. Plast Reconstr Surg 1987; 79: 267–271 Handchir Mikrochir Plast Chir 2010; 42: 129–134
12 Bircoll M, Novack BH. Autologous fat transplantation employing lipo- 29 Eder M, Kovacs L. [Commentary on the article of Herold et al.: The use
suction techniques. Ann Plast Surg 1987; 18: 327–329 of mamma MRI volumetry to evaluate the rates of fat survival after
13 Report on autologous fat transplantation. ASPRS Ad-Hoc Committee autologous lipotransfer]. Handchir Mikrochir Plast Chir 2010; 42:
on New Procedures, September 30, 1987. Plast Surg Nurs 1987; 7: 135–136
140–141 30 Chan CW, McCulley SJ, Macmillan RD. Autologous fat transfer – a re-
14 Gutowski KA. Current applications and safety of autologous fat grafts: view of the literature with a focus on breast cancer surgery. J Plast
a report of the ASPS fat graft task force. Plast Reconstr Surg 2009; Reconstr Aesthet Surg 2008; 61: 1438–1448
124: 272–280 31 Illouz YG, Sterodimas A. Autologous fat transplantation to the breast:
15 Chajchir A, Benzaquen I. Fat-grafting injection for soft-tissue augmen- a personal technique with 25 years of experience. Aesthetic Plast Surg
tation. Plast Reconstr Surg 1989; 84: 921–934; discussion 935 2009; 33: 706–715
16 Chajchir A, Benzaquen I. Liposuction fat grafts in face wrinkles and 32 Rigotti G, Marchi A, Stringhini P et al. Determining the Oncological Risk
hemifacial atrophy. Aesthetic Plast Surg 1986; 10: 115–117 of Autologous Lipoaspirate Grafting for Post-Mastectomy Breast Re-
17 Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: safety construction. Aesthetic Plast Surg 2010
and efficacy. Plast Reconstr Surg 2007; 119: 775–785; discussion 33 Illouz YG. The Fat Cell “Graft”: A New Technique to Fill Depressions.
777–786 In: Plastic and reconstructive surgery 1986; 122–123
18 Coleman SR. Structural fat grafts: the ideal filler? Clin Plast Surg 2001;
28: 111–119
19 Coleman SR. Structural fat grafting. Aesthet Surg J 1998; 18: 386, 388

Ueberreiter K et al. BEAULI™ – A New and Easy Method … Handchir Mikrochir Plast Chir 2010; 42: 379–385