Stem Cells Enriched Fat Transfer for
Breast Reconstruction

Fat grafting is one the new technique in reconstructive breast surgery & rapidly developed into a standard option of breast reconstruction to become a key solution for many patients to address contour deformity after lump excision or used with other reconstructive technique to address contour deformity created by mastectomy to optimize the cosmetic result for patients who have done reconstructive surgery but, still unhappy with uneven chest wall contour, in need to improve soft tissue padding over the chest wall or treat their implant rippling.  

Fat grafting cannot form full breast mould by itself (as it needs more than 4-5 sessions) but can be used in combination with other procedures. In patient with breast asymmetry, fat grafting allows either dramatic or subtle shaping to produce a more aesthetic, symmetrical contour. These small changes are very difficult to achieve without the use of transferred fat. Fat grafting to the breast is a valuable adjunct to breast reconstruction, and with or without alloplastic breast implants, grafting may provide a substitute for much more extensive procedures, such as free flaps.

Common uses of Fat Transfer in breast reconstruction:

  • It can by fat grafting alone correct partial breast defects after lumpectomy (to correct volume deficit).
  • It is used in conjunction with other breast reconstruction techniques to optimize breast contour and improve the final cosmetic results after autologous (flap) reconstruction (to substitute the lost areas of the flap reconstruction)
  • It can help in patient with single-stage breast implant reconstruction who has a visible implant under the very thin skin due to lack of skin padding because the woman naturally thin in the chest area or her mastectomy surgeon has removed so much of the fat in the area of surgery causing what is known as breast implant “rippling” or “wrinkling” created a very thin coverage for the implant. In this situation, fat grafting can somewhat improve the appearance of rippling in this situation; however, this situation is not easy to correct as it needs enough tissue thickness in the area to accept a significant amount fat to be grafted as it can be very hard to inject the fat.
  • It is the primary breast reconstruction technique in male breast cancer patients (to correct shape asymmetries)
  • It can fill in contour defects and improve chest soft tissue padding after mastectomy in patients choosing not to undergo breast reconstruction (to correct surface deformities or scar retraction).

The procedure can be done by using unwanted fat from part of body, liposuction it, process it and re-inject it in the breast. Once the injected fat become viable it helps to improve thickness and quality of skin and soft tissue that has been damaged by radiation. Patient may require more than one procedure for the best result. Studies shows adding adipose derived stem cells cultured or SVF can optimise the result and give best long-lasting result.

Stem cells can assist fat grafting by:

  • Grow new blood vessels to feed the fat
  • Releasing anti-inflammatory substances to help in healing. (Wang et al. 2012)

Releasing the needed growth components and factors which would aid in making the skin tighter in the breasts. (Yoshimura et al. 2009)

Safety of Fat Transfer in breast reconstruction:

A study was designed to evaluate the safety & efficacy of stem cells in breast reconstruction following partial mastectomy & radiation therapy. 21 women were treated with stem cells at least 12 months after radiation therapy was completed. The study concluded the following:

  1. The procedure was safe & well tolerated.
  2. There was no rejection or adverse breast tissue response.
  3. High patient satisfaction rate (79%).
  4. Statistically significant increase in average breast tissue thickness.
  5. No change in the breast tissue thickness from 1 month to the end of the follow-up.

Other several independent studies have evaluated breast cancer patients for years following fat grafting and concluded that fat grafting is oncologically safe procedure.

  • Brazilian prospective and controlled trial published 2015

analysed quantitatively and qualitatively fat grafts in 2 groups of secondary breast reconstructive data collected from that study shows three  years follow up observed No locoregional recurrences were observed after 3 years follow up.

  • Long term outcome Japanese study (7.8 ± 1.5 years) after breast reconstruction published Dec. 2017 showing: ADSC-enriched autologous fat transplantation is thus considered to be safe perioperatively, with NO long-term recurrence for patients with breast cancer treated by breast conserving surgery, & consider it an option for breast reconstruction, even after adjuvant radiotherapy

References:

  1. Arshad, Z., Karmen, L., Choudhary, R., Smith, J. A., Branford, O. A., Brindley, D. A., . . . Davies, B. M. (2016). Cell assisted lipotransfer in breast augmentation and reconstruction: A systematic review of safety, efficacy, use of patient reported outcomes and study quality. Click Here for PDF
  2. Bertolini, F., Petit, J. Y., & Kolonin, M. G. (2015). Stem cells from adipose tissue and breast cancer: hype, risks and hope. Br J Cancer, 112(3), 419-423. doi: 10.1038/bjc.2014.657 Click Here for PDF
  3. Cui SE, Li HM, Liu DL, Nan H, Xu KM, Zhao PR,
    Liang SW. Human breast adipose-derived stem cells: characterization and differentiation into mammary gland like
    epithelial cells promoted by autologous activated platelet-rich plasma. Mol Med Rep. 2014; 10:605-14.
  4. Del Vecchio D. Breast reconstruction for breast asymmetry using recipient site pre-expansion and autologous fat grafting: a case report. Ann Plast Surg. 2009;62:523-527. Click Here for PDF
  5. Eto H, Suga H, Matsumoto D, Inoue K, Aoi N, Kato H, Araki J, Yoshimura K. Characterization of structure and cellular components of aspirated and excised adipose tissue. Plast Reconstr Surg. 2009;124(4):1087-97 Click Here for PDF
  6. Eto H, Kato H, Suga H, Aei N, Doi K, Kuno S, Yoshimura K, The fate of adipocytes after neovascularized fat grafting: evidence of early death and replacement of adipocytes. Plast Reconstr Surg. 2012;129(5): 1080-92 Click Here for PDF
  7. Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini
    I, Curcio CB, Floris M, Fiaschetti V, Floris R, Cervell V.
    A comparative translational study: the combined use of
    enhanced stromal vascular fraction and platelet-rich plasma
    improves fat grafting maintenance in breast reconstruction.
    Stem Cells Transl Med. 2012; 1:341-51
  8. Jung, H. K., Kim, C. H., & Song, S. Y. (2016). Prospective 1-Year Follow-Up Study of Breast Augmentation by Cell-Assisted Lipotransfer. Aesthet Surg J, 36(2), 179-190. Click Here for PDF
  9. Katzel EB, Bucky LP. Fat Grafting to the Breast: Clinical Applications and Outcomes for Reconstructive Surgery. Plast Reconstr Surg. 2017 Nov;140(5S Advances in Breast Reconstruction):69S-76S. Click Here for PDF
  10. Khouri R, Del Vecchio D. Breast reconstruction and augmentation using pre-expansion and autologous fat transplantation. Clin Plast Surg. 2009;36:269-280. Click Here for PDF
  11. Kitamura K, Mori M, Sugimachi K. Stem Cells augmented reconstruction: a new hope for reconstruction after breast conservative therapy, 2007. 30th annual San Antonio breast cancer symposium (poster presentation), San Antonio, 13-17 Dec.2007. Click Here for PDF
  12. Lu F, Misuno H, Uysal CA, Cai X, Ogawa R, Hyakusoku H, Improved viability of random pattern skin flaps through the use of adipose-derived stem cells. Plast Reconstr Surg. 2008;121(1):59-8 Click Here for PDF
  13. Perez-Cano R, Vranckx JJ, Lasso JM, Calabrese C, Merck B, Milstein AM, Sassoon E, Delay E, Weiler-Mithoff EM. Prospective trial of adipose-derived regenerative cell(ADRC)-enriched fat grafting for partial mastectomy defects: The restore-2 trial. Eur J Surg Oncol. 2012;38(5):382-9 Click Here for PDF
  14. Philips BJ, Marra KG, Rubin JP. Healing of grafted adipose tissue: current clinical applications of adipose-derived stem cells for breast and face reconstruction. Wound Repair Regen. 2014; 22:11-3.
  15. Rigotti G, Marchi A, Galiè M, et al. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg. 2007;119:1409-1422. Click Here for PDF
  16. Ru-Lin Huang, Yun Xie, Wenjin Wang, Tanja Herrler, Jia Zhou, Peijuan Zhao, Lee LQ Pu, Qingfeng Li. Anatomical Study of Temporal Fat Compartments and its Clinical Application for Temporal Fat Grafting. Aesthetic Surgery Journal. Sep 2017, Vol. 37, No. 8: 855-86 Click Here for PDF
  17. Shuhei Ito, Yuichiro Kai, Takaaki Masuda, Fumiaki Tanaka, Toshifumi Matsumoto, Yukio Kamohara, Hiroshi Hayakawa, Hiroaki Ueo, Hideki Iwaguro, Marc H. Hedrick, Koshi Mimori, Long-term outcome of adipose-derived regenerative cell-enriched autologous fat transplantation for reconstruction after breast-conserving surgery for Japanese women with breast cancer. Masaki MoriSurgery Today. Dec 2017, Vol. 47, No. 12: 1500-1511 
  18. Sinna R, Delay E, Garson S, Delaporte T, Toussoun G. Breast fat grafting (lipomodelling) after extended latissimus dorsi flap breast reconstruction: a preliminary report of 200 consecutive cases. J Plast Reconstr Aesthetic Surg. 2010;63:1769-1777. Click Here for PDF
  19. Sterodimas A, de Faria J, Nicaretta B, Boriani F, Autologous fat transplantation versus adipose-derived stem cell-enriched lipografts: a study. Asethet. Surg. J. 2011;31(6):682-93 
  20. Tiryaki t, Findikli N, Tiryaki D.Steged stem cells enriched tissue (SET) injection for soft tissue augmentation in hostile recipient areas: a preliminary report. Aesthetic palst Surg.2011;35(6):965-71
  21. Tissiani, N. AlonsoStem A Prospective and Controlled Clinical Trial on Stromal Vascular Fraction Enriched Fat Grafts in Secondary Breast Reconstruction. L. A. L. Cells International. Jan 2016, Vol. 2016: 1-12 
  22. Toyserkani NM, Jensen CH, Sheikh SP, Sørensen JA. Cellassisted
    lipotransfer using autologous adipose-derived
    stromal cells for alleviation of breast cancer-related
    lymphedema. Stem Cells Transl Med. 2016; 5:857-9.
  23. Uysal AC, Misuno H, To bita M, Ogawa R, Hyakusoku H, The effect of adipose derived stem cells on ischaemia  reperfusion injury: immunohistochemical and ultrastructural evaluation. Plast Reconstr Surg. 2009;124(3):804-15 Click Here for PDF
  24. Wang, Lin, Yi Lu, Xuan Luo, Min-Gang Fu, Xiang Hu, Hui Dong, and Zhi-Hong Fan. 2012. [Cell-assisted lipotransfer for breast augmentation: a report of 18 patients]. Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery, no. http://www.ncbi.nlm.nih.gov/pubmed/22497178. Click Here for PDF
  25. Yoshimura, Kotaro, Yuko Asano, Noriyuki Aoi, Masakazu Kurita, Yoshio Oshima, Katsujiro Sato, Keita Inoue, et al. 2009. Progenitor-enriched adipose tissue transplantation as rescue for breast implant complications. The breast journal, no. 2 (November 12). Click Here for PDF
  26. Yoshimura K, Sato K, Aoi N, Kurta M, Hirohi T, Harii K, Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg. 2008;32(1): 48-55

A study was designed to evaluate the safety & efficacy of stem cells in breast reconstruction following partial mastectomy and radiation therapy. 21 women were treated with stem cells at least 12 months after radiation therapy was completed. the study concluded the following:

  1. The procedure was safe & tolerated.
  2. There was no rejection or adverse immune response.
  3. High satisfactory rate (79%).
  4. Statistically significant increase in average breast tissue thickness.
  5. No change in the breast tissue thickness from 1 month to the end of followup.

Other several independent studies have evaluated breast cancer patients for years following fat grafting and concluded that fat grafting is oncologically safe procedure.

  • Brazilian prospective and controlled trial published 2015

analysed quantitatively and qualitatively fat grafts in 2 groups of secondary breast reconstructive data collected from that study shows three  years follow up observed No locoregional recurrences were observed after 3 years follow up.

Long term outcome Japanese study (7.8 ± 1.5 years) after breast reconstruction published Dec. 2017 showing: ADSC-enriched autologous fat transplantation is thus considered to be safe perioperatively, with NO long-term recurrence for patients with breast cancer treated by breast conserving surgery, & consider it an option for breast reconstruction, even after adjuvant radiotherapy

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