What Is Rigottomia (Rigottomy)? The Fat-Grafting Technique Explained

Rigottomia — known in English as rigottomy — is a minimally invasive surgical technique that prepares tight, fibrous or scarred tissue to receive a fat graft. Using a fine needle or blade passed through the skin, the surgeon makes many tiny releases inside the tissue, turning a stiff, restricted area into a soft, three-dimensional mesh that grafted fat can settle into and survive. It is one of the quiet enabling ideas behind modern fat grafting, and this guide explains what it is, how it works, and where it is used.

What does the word rigottomia mean?

The technique is named after the Italian plastic and reconstructive surgeon Gino Rigotti, who helped pioneer the use of the patient’s own fat to regenerate damaged tissue. “Rigottomia” is the Italian form of the word; “rigottomy” and the plural “rigottomies” are the terms most often used in English-language surgery. In the medical literature the same manoeuvre is also described as percutaneous fasciotomy or percutaneous aponeurotomy — “percutaneous” simply meaning “through the skin,” without an open incision.

The problem rigottomia solves

Fat grafting works by transferring small parcels of a patient’s own fat into an area that needs volume or softening. For that fat to survive, it needs two things from the tissue receiving it: space to sit in and a blood supply to feed it. Healthy, supple tissue provides both. But scarred, irradiated, burned or congenitally tight tissue does not — it is stiff, contracted and poorly vascularised. Injecting fat into such a bed under pressure tends to create large pools of fat that the body cannot nourish, and much of the graft is simply reabsorbed.

Rigottomia changes the recipient site itself, so the tissue is ready to accept and keep the graft — rather than forcing fat into a bed that cannot support it.

How rigottomia works, step by step

1. Releasing the tissue

The surgeon passes a fine needle or a small blade through tiny punctures in the skin and makes numerous small cuts through the fibrous bands and tight connective-tissue layers (the aponeurosis) that are restricting the area. Each release is deliberately small — on the order of a couple of millimetres — and there may be dozens of them.

2. Creating a three-dimensional mesh

Rather than one large cut, the many small releases expand the tissue into a lattice of micro-cavities. The scar or fibrous plate is effectively converted into a loose, open, three-dimensional matrix. Crucially, this is done without creating large empty pockets: wide subcutaneous cuts leave “macrocavities” where fat collects and dies, which is exactly what the technique avoids.

3. Seeding the mesh with fat

The many micro-openings are then seeded with small parcels of fat — microgrfating. Because the fat is distributed as tiny droplets through a released, better-vascularised bed, far more of each graft sits close to living, blood-supplied tissue, which is the single biggest factor in graft survival.

Rigottomia and structural fat grafting

Rigottomia is rarely a standalone operation; it is a preparation step that makes structural fat grafting more reliable. The two most influential ideas it is paired with are Sydney Coleman’s structural fat grafting (placing fat in fine, evenly distributed parcels) and Roger Khouri’s work on external tissue expansion and recipient-site conditioning. Rigotti and Khouri are usually credited together with turning percutaneous release into standard practice for “inhospitable” recipient tissue. The quality of the fat itself matters too: gentle harvesting and clean processing that preserve the regenerative stromal vascular fraction give the seeded graft the best chance to take.

Where rigottomia is used

• Scars and burns. Releasing contracted scar tissue and grafting fat into the resulting mesh can soften, expand and regenerate the area — a regenerative alternative to flap surgery in selected cases.
• Tuberous and constricted breasts. The fibrous ring that constricts a tuberous breast can be released with rigottomies and the lower pole expanded and volumised with fat. See our dedicated guide on rigottomia for tuberous breast and areola release.
• Breast reconstruction. After mastectomy or radiotherapy the chest wall is often tight and thin; rigottomia helps prepare it to accept fat as part of a wider reconstruction plan.
• Radiation-damaged and irradiated tissue. Fat grafting into released, irradiated skin is a well-known application of the regenerative principle behind the technique.

Why the technique matters

Rigottomia embodies a shift in reconstructive surgery: from moving large blocks of tissue to re-engineering the recipient site so the body can rebuild itself. By turning restrictive, poorly supplied tissue into a receptive, vascularised scaffold, it widens the range of problems that fat grafting can address — and it does so through a few millimetre-sized punctures rather than long incisions and visible scars.

The bottom line

Rigottomia (rigottomy) is the percutaneous release of tight or scarred tissue into a three-dimensional mesh that fat grafts can be seeded into and survive within. It is a preparation technique — the partner to good fat harvesting and structural grafting — and it underpins better outcomes in scars, burns, tuberous breasts and reconstruction. To understand the grafting side of the equation, read our guide to fat grafting and how fat processing affects graft survival.

This article is general educational information about a surgical technique and is not medical advice. Decisions about any procedure should be made with a qualified surgeon who can assess your individual situation.