Autologous fat transplantation for breast reconstruction: A literature review

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Abstract

Introduction

The use of autologous fat transplantation to correct volume and contour defects, scars, and asymmetry after breast cancer surgery has increased over the past 20 years. Many developments and refinements in this technique have taken place in recent years, and several studies of the safety of lipofilling in the breast have been published.

Presentation of case

We performed a literature review of this technique, highlighting the crucial role of lipofilling in breast cancer reconstruction.

Discussion

The efficacy of the fat graft transplantation depends on the experience and the technique used by the surgeon. The ASCs (adipose-derived stem cells) contained in the fat graft has proven to be crucial for breast reconstruction by mean the regeneration of tissue, through the chemotactic, paracrine, and immunomodulatory activities and their in situ differentiation.

Conclusion

The role of lipofilling for breast reconstruction could be more significant with the application of the findings of experimental research on tissue engineering and ASCs.

Highlights

•

Autologous fat transplantation does not compromise oncological outcomes and minimizes discomfort to the patients.
•

The ASCs (adipose-derived stem cells) into the fat graft allow the regeneration of tissue after breast reconstruction.
•

The role of lipofilling could be more significant with the findings of experimental research on tissue engineering and ASCs.

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Most cited references 80

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Adipose tissue derived stem cells secretome: soluble factors and their roles in regenerative medicine.

António J Braga Osório Gomes Salgado, RuI Reis, Nuno Jorge Carvalho Sousa … (2010)

Stem cells have been long looked at as possible therapeutic vehicles for different health related problems. Among the different existing stem cell populations, Adipose- derived Stem Cells (ASCs) have been gathering attention in the last 10 years. When compared to other stem cells populations and sources, ASCs can be easily isolated while providing simultaneously higher yields upon the processing of adipose tissue. Similar to other stem cell populations, it was initially thought that the main potential of ASCs for regenerative medicine approaches was intimately related to their differentiation capability. Although this is true, there has been an increasing body of literature describing the trophic effects of ASCs on the protection, survival and differentiation of variety of endogenous cells/tissues. Moreover, they have also shown to possess an immunomodulatory character. This effect is closely related to the ASCs' secretome and the soluble factors found within it. Molecules such as hepatocyte growth factor (HGF), granulocyte and macrophage colony stimulating factors, interleukins (ILs) 6, 7, 8 and 11, tumor necrosis factor-alpha (TNF-alpha), vascular endothelial growth factor (VEGF), brain derived neurotrophic factor (BDNF), nerve growth factor (NGF), adipokines and others have been identified within the ASCs' secretome. Due to its importance regarding future applications for the field of regenerative medicine, we aim, in the present review, to make a comprehensive analysis of the literature relating to the ASCs' secretome and its relevance to the immune and central nervous system, vascularization and cardiac regeneration. The concluding section will highlight some of the major challenges that remain before ASCs can be used for future clinical applications.

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Fat grafting to the breast revisited: safety and efficacy.

Denis Coleman, Alesia Saboeiro (2007)

A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper. This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland's syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels. All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure. Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure.

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The potential of adipose stem cells in regenerative medicine.

Riitta Suuronen, Bettina Lindroos, Susanna Miettinen (2011)

Adipose stem cells (ASCs) are an attractive and abundant stem cell source with therapeutic applicability in diverse fields for the repair and regeneration of acute and chronically damaged tissues. Importantly, unlike the human bone marrow stromal/stem stem cells (BMSCs) that are present at low frequency in the bone marrow, ASCs can be retrieved in high number from either liposuction aspirates or subcutaneous adipose tissue fragments and can easily be expanded in vitro. ASCs display properties similar to that observed in BMSCs and, upon induction, undergo at least osteogenic, chondrogenic, adipogenic and neurogenic, differentiation in vitro. Furthermore, ASCs have been shown to be immunoprivileged, prevent severe graft-versus-host disease in vitro and in vivo and to be genetically stable in long-term culture. They have also proven applicability in other functions, such as providing hematopoietic support and gene transfer. Due to these characteristics, ASCs have rapidly advanced into clinical trials for treatment of a broad range of conditions. As cell therapies are becoming more frequent, clinical laboratories following good manufacturing practices are needed. At the same time as laboratory processes become more extensive, the need for control in the processing laboratory grows consequently involving a greater risk of complications and possibly adverse events for the recipient. Therefore, the safety, reproducibility and quality of the stem cells must thoroughly be examined prior to extensive use in clinical applications. In this review, some of the aspects of examination on ASCs in vitro and the utilization of ASCs in clinical studies are discussed.

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Author and article information

Contributors

Francesco Simonacci

Journal

Journal ID (nlm-ta): Ann Med Surg (Lond)

Journal ID (iso-abbrev): Ann Med Surg (Lond)

Title: Annals of Medicine and Surgery

Publisher: Elsevier

ISSN (Electronic): 2049-0801

Publication date PMC-release: 23 November 2016

Publication date Collection: December 2016

Publication date (Electronic): 23 November 2016

Volume: 12

Pages: 94-100

Affiliations

[a ]Department of Surgical Sciences, Plastic Surgery Division, University of Parma, Parma, Italy

[b ]The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy

Author notes

[∗ ]Corresponding author. The Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy.The CutaneousMininvasiveRegenerative and Plastic Surgery UnitParma University HospitalVia Gramsci 14Parma43126Italy francescosimonacci@ 123456hotmail.it

Article

Publisher ID: S2049-0801(16)30158-3

DOI: 10.1016/j.amsu.2016.11.012

PMC ID: 5137333

PubMed ID: 27942383

SO-VID: 22e96531-f033-45ba-b117-c074b26e6b4b

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Autologous fat transplantation for breast reconstruction: A literature review

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Abstract

Introduction

Presentation of case

Discussion

Conclusion

Highlights

Related collections

GLUT4 biology

Most cited references 80

Adipose tissue derived stem cells secretome: soluble factors and their roles in regenerative medicine.

Fat grafting to the breast revisited: safety and efficacy.

The potential of adipose stem cells in regenerative medicine.

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Contributors

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Author notes

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