Cell Enriched Fat Transfer “CAL” to Breast “Overview”

Fat Transfer to Breast

Fat transfer to breast, also known as “fat grafting” or “Lipo-filling” of breast, is the latest advancement in breast enlargement and reconstruction. Fat grafting is commonly used in plastic surgery not just for body reshaping and contouring but also as a reconstructive tool to correct tissue of body that has deficiency in volume whether due to congenital cause, after trauma or end result of surgical intervention like tumour excision or end result of improper liposuction. In breast, it has been used to use it for secondary breast revision surgery specially after breast lump excision or minor outpatient touch-up procedure after the initial procedure to optimise the outcome.

 Fat grafting, is the process of harvesting fat cells from a part of the body where they are in excess, using liposuction as a reconstructive too. The area where fat is harvested from is called the “donor area”. Most commonly used areas are; abdomen, thighs, flanks areas, and/or arm, wherever the patient stores their stubborn unwanted fat. Fat graft harvest usually occurs under local anaesthesia with sedation, spinal anaesthesia and in less commonly under general anaesthesia, in a sterile environment at the operating room. This allow surgeons to harvest the fat from the areas where it is unwanted & abundance, such as abdomen, flanks, hips &/or thighs. The amount to harvest according to the needed amount of fat to be grafted (small breast defect or small size breast that can tolerate small amount of grafted fat) or according to the availability of donor areas.

In the last years, breast lipofilling has rapidly developed into a standard option in primary breast augmentation & breast reconstruction. Currently, fat grafting to the breast is a treatment option in conditions other than, micromastia (tinny size breast) but can be used in cases like breast ptosis, post mastectomy breast reconstruction, asymmetric breast, congenital malformation of the breast, and for treatment of complications associated with implant augmentation mammaplasty. The most advances of fat transfer technique are the stem cells enriched lipo-filling of breast.

Combined Stem Cells with Fat Grafting to Optimize the Outcomes

Some researchers have reported a varied range of improvements in soft tissue conditions after adding fat transfer, including radiation damage skin, breast capsular contracture, damaged vocal cords and chronic ulceration as well as regrowth of bone. While many of the exact mechanism for these effects remain to be described, what seems to be at the centre of these changes is the presence of adipose-derived stem cells (ADSCs) in human adipose tissue. In fact, it has been proven to be the most abundant sources of stem cells in the body.

The big limit that was observed with fat transfer is the percentage of resorption of the fat tissue injected (40-80 %). Despite cumulative information from years of numerous basic, preclinical & clinical pilot investigations, no consensus has been reached for an accepted evidence-based method to achieve superior and reliable clinical results after traditional fat grafting. Within the past decade, two separate autologous cell approaches have emerged in the clinical setting as promising therapies to improve fat grafting. Of the two.

The combination of adipose tissue either with adipose stem cells (ASCs) from stromal vascular fraction (SVF) or

Adipose derived stem cells (ADSCs) isolated after SVF adherent plating and culture expansion has been the most controversial strategy.

Today, ADSCs (Adipose-derived Mesenchymal Stem Cells) has become one of the most popular adult stem cells populations for research in soft tissue engineering and regenerative medicine applications. Compared with other stem cells sources, ADSCs offer several advantages including abundant autologous source, minor invasive harvesting (liposuction), significant proliferative capacity in culture, and multi-lineage potential.

To harvest the adipose tissue, a liposuction procedure is less invasive than bone-marrow aspiration, and the technique produces less patient discomfort and donor site morbidity. Small amounts of adipose tissue yield approximately 5×103 stem cells, which is 500-fold greater than the number of MSCs in 1 gm of bone marrow.

Benefits of Stem Cells in a Fat Transfer

  1. Grow new blood vessels to nourish the fat.
  2. Release anti-inflammatory agents to aid healing.
  3. Generate and release growth factors that support graft survival
  4. Improve skin tightening and rejuvenation.
  5. No risk of allergic or adverse reaction.
  6. The therapeutic target is simply moving stem cells from one connective tissue where they are abundant into another in which they are scarce.

Fat grafting enriched with ADSCs may be considered today for breast augmentation and correction of defects associated with medical conditions and previous breast surgeries.

Fat grafting to the breast could be potentially interfere with breast cancer detections: however, no evidence was found that strongly suggest this interference… Radiological studies suggest that imaging technologies (ultrasound, mammography, & MRI) can identify the grafted fat tissue, microcalcifications and suspicious lesions; biopsies may be performed if needed for additional clarification.

Concern about Fat Transfer to Breast

Fat grafting is gaining preference because it utilizes an autologous material that is abundant and can be harvested with minimal scarring; however, as with any surgical manipulation of the breast, fat grafting is associated with several complications, such as fat necrosis & the development of calcifications, cysts, or palpable lumps. Scientifically, fat grafting to the breast results in fewer radiographic abnormalities than breast reduction mammaplasty.

The fact that fat grafting for breast augmentation has previously been prohibited by the American Society of Plastic Surgeons (ASPS) due to concerns that fat grafting to the breast region would impede breast cancer detection. This prohibition was revised in 2009 following a review of the literature of numerous patients who underwent fat grafting, 238 of whom underwent fat grafting to the breast. It was noted that fat grafting to the breast had become more refined and breast cancer detection methods more sophisticated. The ASPS Task Force concluded that fat grafting could be considered for the correction of defects associated with medical conditions and previous breast operations, as well as breast augmentation, although results are dependent on technique and surgeon expertise.

References:

  1. Cervilli V, Gentile P, Scioli MG et al (2009) Application of platelet-rich plasma in plastic surgery: clinical and in vitro evaluation. Tissue Eng Part C Methods 15:625–634 Click Here for PDF
  2. Chang Q, Li J, Dong Z et al (2013) Quantitative volumetric analysis of progressive hemifacial atrophy corrected using stromal vascular fraction—supplemented autologous fat grafts. Dermatol Surg. 39:1465–1473 Click Here for PDF
  3. Choi J, Minn KW, Chang H (2012) The efficacy and safety of platelet-rich plasma and adipose-derived stem cells: an update. Arch Plast Surg 39:585–592 Click Here for PDF
  4. Cohen SR, Mailey B (2012) Adipocyte-derived stem and regenerative cells in facial rejuvenation. Clin Plastic Surg 39:453–464 Click Here for PDF
  5. Coleman SR. Augmentation of the breast with structural fat. In: Coleman SR, Mazzola RF, editors, Fat Injection from Filling to Regeneration.Quality Medical Publishing, Inc.; 2009, p.501-544. 
  6. Daher SR, Johnstone BH, Phinney DG et al (2008) Adipose stromal/stem cells: basic and translational advances: the IFATS collection. Stem Cells 26:2664–2665 Click Here for PDF
  7. Gir P, Brown SA, Oni G et al (2012) Fat grafting: evidence-based review on autologous fat harvesting, processing, reinjection, and storage. Plast Reconstr Surg 130:249–258 Click Here for PDF
  8. Kaufman MR, Bradley JP, Dickinson B et al (2007) Autologous fat transfer national consensus survey: trends in techniques for harvest, preparation, and application, and perception of short-and long-term results. Plast Reconstr Surg 119:323–331 Click Here for PDF
  9. Kølle SF, Fischer-Nielsen A, Mathiasen AB, Elberg JJ, Oliveri RS, Glovinski PV, Kastrup J, Kirchhoff M, Rasmussen BS, Talman ML, Thomsen C, Dickmeiss E, Drzewiecki KT. Enrichment of augtologous fat graft with ex-vivo expanded adipose tissue-derived stem cells for graft survival: a randomised placebo-controlled trial. Lancet. 2013 Sep doi: 10.1016/S0140-6736(13)61410-5. PubMed PMID: 24075051 
  10. Li J, Gao J, Cha P et al (2013) Supplementing fat grafts with adipose stromal cells for cosmetic facial contouring. Dermatol Surg 39:449–456 Click Here for PDF
  11. Llull R (2005) Cited as Personal Communication in manuscript by Moseley TA, Zhu M, Hedrick MH (2006) Adipose-derived stem and progenitor cells as fillers in plastic and reconstructive surgery. Plast Reconstr Surg 118 (Suppl.):121S Click Here for PDF
  12. Marx RE (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62:489–496 Click Here for PDF
  13. Peltoniemi HH, Salmi A, Miettinen S et al (2013) Stem cell enrichment does not warrant a higher graft survival in lipofilling of the breast: a prospective comparative study. J Plast Reconstr Aesthet Surg 66:1494–1503 Click Here for PDF
  14. Sadati KS, Corrado AC, Alexander RW (2006) Platelet-rich plasma (PRP) utilized to promote greater graft volume retention in autologous fat grafting. Am J Cosmet Surg 23:203–211 Click Here for PDF
  15. Sterodimas A, de Faria J, Nicaretta B et al (2010) Tissue engineering with adipose-derived stem cells (ADSCs): current and future applications. J Plast Reconstr Aesthet Surg 63:1886–1892 Click Here for PDF
  16. Sterodemas A, de Faria J, Nicaretta B et al (2011) Autologous fat transplantation versus adipose-derived stem cell-enriched lipografts: a study. Aesthet Surg J 31(6):682–693 
  17. Tiryaki T, Findikli Tiryaki D (2011) Staged stem cell-enriched tissue (SET) injections for soft tissue augmentation in hostile recipient areas: A preliminary report. Aesth Plast Surg 35:965–971 Click Here for PDF 
  18. Yoshimura K, Sato K, Aoi N et al (2008) Cell-assisted lipotransfer for facial lipoatrophy: efficacy of clinical use of adiposederived stem cells. Dermatol Surg 34:1178–1185 Click Here for PDF
  19. Yoshimura K, Sato K, Aoi N et al (2008) Cell-assisted lipotransfer (CAL) for cosmetic breast augmentation—supportive use of adipose-derived stem/stromal cells. Aesthet Plast Surg. 32(1):48–55 Click Here for PDF
  20. Zhu M, Zhou Z, Chen Y, Schreiber R, Ransom JT, Fraser JK, Hedrick Mh, Pinkernell K, Kuo HC. Supplementation of fat grafts with adipose-derived regenerative cells improves long-term graft retention. Ann Plast Surg. 2010;64(“):267-71 Click Here for PDF 
  21. Zuk PA, Zhu M, Mizuno H et al (2001) Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 7:211–228 Click Here for PDF
  22. Zuk PA, Zhu M, Ashjian P, De Ugarte DA, Huang JI, Mizuno H, Alfonso ZC, Fraser JK, Benhaim P, Hedrick MH. Human asipose tissue is a source of multipotent stem cells . Mol Biol Cell. 2002;13(12):4279-95. Click Here for PDF

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