Peristaltic Pump-Assisted Fat Harvesting and Closed-Circuit Grafting: Technique and Immediate Cell Membrane Integrity in a Case Series.

Autologous fat grafting outcomes are influenced by tissue handling during harvest, processing, and reinjection. Traditional vacuum-based suction systems generate variable subatmospheric pressures and may introduce turbulence and shear forces that can affect adipocyte viability. The aim of this study was to describe a reversible peristaltic pump-assisted technique alternative for fat harvest and grafting and to outline its procedural workflow and mechanistic considerations. This report describes a closed-circuit, peristaltic pump-assisted technique based on the authors' 5-year clinical experience across more than 160 aesthetic and reconstructive procedures. The technique enables bidirectional flow for controlled aspiration and reinjection without direct handling of the tissue. The technique was applied across multiple anatomic regions, including the face, breast, and body. Tumescent infiltration, aspirate, and graft volumes were adjusted based on anatomic location and procedural goals. Intraoperative handling was characterized by continuous flow, minimal air entrainment, and minimal clogging. The technique was used for both aesthetic and reconstructive operations, including breast procedures. Peristaltic pump-assisted fat harvest and grafting represent a closed-circuit, non-vacuum-based approach to autologous fat transfer and an alternative in fat grafting technique. By combining precise pressure regulation with an adaptable closed-loop architecture, this method may contribute to consistent and reproducible graft quality, reduce tissue trauma, and decrease surgeon fatigue. This descriptive report demonstrates technical feasibility and reproducible intraoperative handling characteristics. Further controlled studies are needed to evaluate clinical outcomes and comparative effectiveness. Level of Evidence: 4 (Therapeutic) For image description, please refer to the figure legend and surrounding text.