{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:46:18Z","timestamp":1790786778495,"version":"4.1.0"},"reference-count":19,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T00:00:00Z","timestamp":1627344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In the last 20 years, surgical procedures in breast remodeling during mammoplasty have been deeply modified with a gradual shifting from an invasive intervention using definitive implants (DIs) to a more conservative autologous fat grafting (AFG). AFG has been used for many years as bioactive material through the Lipofilling technique and as a bioactive scaffold when it was enriched with adipose-derived stem cells (ASCs), while DIs have been considered physiologically inert biomaterials with low toxicity. The paper aimed to compare the breast remodeling results obtained in the DI group (55 patients) for hypoplasia correction with those of the ASC-enhanced AFG group (50 patients), also analyzing the influence of breast and chest deformities (tuberous breast, volume, and nipple\u2013areola complex asymmetry, pectus excavatum and carinatum) in the cosmetic outcome. A retrospective, case-control study was conducted. The pre-operative analysis was performed with an accurate clinical evaluation, a photographic assessment, and an instrumental evaluation based on magnetic resonance imaging, mammography, and ultrasound. Of patients treated with DIs 89% (n = 49) showed excellent cosmetic results after 1 year compared with the patients treated with AFG, who showed the same results in 64% (n = 32) of cases. The naturalness of the results in the AFG group was higher than that in the DI group (p &lt; 0.0001 vs. DI group). DIs and AFG were safe and effective in this case series treated. The AFG group showed more natural results, allowing the treatment of patients with pectus excavatum, while DIs showed the more evident and lasting result.<\/jats:p>","DOI":"10.3390\/jcm10153310","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T12:18:31Z","timestamp":1627388311000},"page":"3310","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Breast Silicone Gel Implants versus Autologous Fat Grafting: Biomaterials and Bioactive Materials in Comparison"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3123-3977","authenticated-orcid":false,"given":"Pietro","family":"Gentile","sequence":"first","affiliation":[{"name":"Department of Surgical Science, \u201cTor Vergata\u201d University, 00133 Rome, Italy"},{"name":"Academy of International Regenerative Medicine & Surgery Societies (AIRMESS), 1201 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1093\/asj\/sjv181","article-title":"Challenging Breast Augmentations: The Influence of Preoperative Anatomical Features on the Final Result","volume":"36","author":"Bayram","year":"2016","journal-title":"Aesthet. Surg. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1093\/asj\/sjz292","article-title":"Fat Graft Enhanced with Adipose-Derived Stem Cells in Aesthetic Breast Augmentation: Clinical, Histological, and Instrumental Evaluation","volume":"40","author":"Gentile","year":"2020","journal-title":"Aesthet. Surg. J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Gentile, P., Casella, D., Palma, E., and Calabrese, C. (2019). Engineered Fat Graft Enhanced with Adipose-Derived Stromal Vascular Fraction Cells for Regenerative Medicine: Clinical, Histological and Instrumental Evaluation in Breast Reconstruction. J. Clin. Med., 8.","DOI":"10.3390\/jcm8040504"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e406","DOI":"10.1097\/GOX.0000000000000285","article-title":"Breast Reconstruction with Enhanced Stromal Vascular Fraction Fat Grafting: What Is the Best Method?","volume":"8","author":"Gentile","year":"2015","journal-title":"Plast. Reconstr. Surg. Glob. Open."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s00266-005-0178-x","article-title":"Breast asymmetries: A brief review and our experience","volume":"30","author":"Araco","year":"2006","journal-title":"Aesthetic. Plast. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/1467-8519.00187","article-title":"International research ethics","volume":"14","author":"Schuklenk","year":"2000","journal-title":"Bioethics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"120","DOI":"10.4103\/JCAS.JCAS_24_18","article-title":"Gentle Is Better: The Original \u201cGentle Technique\u201d for Fat Placement in Breast Lipofilling","volume":"11","author":"Gentile","year":"2018","journal-title":"J. Cutan. Aesthet. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.breast.2006.08.004","article-title":"Technical tricks to improve the cosmetic results of breast-conserving treatment","volume":"16","author":"Petit","year":"2007","journal-title":"Breast"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1097\/01.PRS.0000049636.17522.1B","article-title":"Incidence of breast and chest wall asymmetry in breast augmentation: A retrospective analysis of 100 patients","volume":"111","author":"Rohrich","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1097\/01.prs.0000189206.94466.a9","article-title":"The incidence of tuberous breast deformity in asymmetric and symmetric mammaplasty patients","volume":"116","author":"Piazza","year":"2005","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"395e","DOI":"10.1097\/PRS.0b013e3182284c05","article-title":"The impact of obesity on breast surgery complications","volume":"128","author":"Chen","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Valente, D.S., Zanella, R.K., Doncatto, L.F., and Padoin, A. (2014). Incidence and risk factors of Striae Distensae following breast augmentation surgery: A cohort study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0097493"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1097\/00000637-197801000-00010","article-title":"Skeletal and postural relations in augmentation mammaplasty","volume":"1","author":"Fredricks","year":"1978","journal-title":"Ann. Plast. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1007\/s00266-010-9506-x","article-title":"Correlation between scoliosis and breast asymmetries in women undergoing augmentation mammaplasty","volume":"34","author":"Tsai","year":"2010","journal-title":"Aesthetic. Plast. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s00266-009-9324-1","article-title":"Breast augmentation in asymmetrically placed nipple-areola complex in the horizontal axis: Lateralization of implant pocket to offset lateralised nipples","volume":"33","author":"Khan","year":"2009","journal-title":"Aesthetic. Plast. Surg."},{"key":"ref_17","first-page":"43","article-title":"Five methods of breast volume measurement: A comparative study of measurements of specimen volume in 30 mastectomy cases","volume":"5","author":"Kayar","year":"2011","journal-title":"Breast Cancer."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.crad.2012.05.009","article-title":"Radiological findings in mammary autologous fat injections: A multi-technique evaluation","volume":"68","author":"Costantini","year":"2013","journal-title":"Clin. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.bjps.2017.02.011","article-title":"Correction of tuberous breast deformity: A retrospective study comparing lipofilling versus breast implant augmentation","volume":"70","author":"Brault","year":"2017","journal-title":"J. Plast. Reconstr. Aesthet. 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