Stemness and clinical performance of water-jet technology: A translational study in breast reconstruction

Autologous fat grafting has become integral to breast reconstruction, yet variability in graft retention continues to challenge its reliability. This study aimed to characterize the biological and clinical properties of adipose tissue harvested using Body-Jet water-assisted liposuction (WAL) technology. A cohort of 171 patients undergoing 206 lipofilling procedures was analyzed, alongside in vitro studies evaluating adipose-derived cell viability, proliferative capacity, and molecular profile. Lipoaspirates obtained using Body-Jet demonstrated high cellular viability, robust mesenchymal stem cell proliferation (doubling time ∼15 hours), and consistent trilineage differentiation (adipogenic, osteogenic, and chondrogenic). Gene expression and secretome analyses revealed a regenerative molecular signature, including balanced cytokine, growth factor, and extracellular matrix protein profiles. Clinically, the WAL approach was associated with low postoperative pain (mean NRS 3.17), minimal complications, and high patient satisfaction, as assessed using BREAST-Q outcomes. A significant correlation emerged between BMI and harvested fat volume, with no association between pain and BMI or donor site. These findings support the hypothesis that Body-Jet–based liposuction yields biologically viable and regenerative lipoaspirates, while offering favorable clinical tolerability. Although transient side effects such as edema and bruising were observed, the overall safety and quality of harvested tissue support the further use of WAL in fat grafting. Prospective controlled studies are needed to confirm long-term outcomes and comparative efficacy.