Cell-Assisted Lipotransfer in Breast Augmentation Surgery: Clinical Outcomes and Considerations for Future Research

Dimitrios Asimakopoulos,John M Anastasatos

doi:10.7759/cureus.22763

Abstract

Autologous fat transfer is a widely used surgical technique, chosen by numerous plastic surgeons for breast augmentation surgery. This technique is based on three steps: 1. harvesting of the lipoaspirate from the patient, 2. centrifugation and removal of the top, oily, layer, and 3. implantation in the patient’s breast(s). It has been associated with various complications, including post-surgical fat resorption, as measured quantitatively with MRI, CT, and other 3D-quantification systems.Adipose-derived stem cells have been explored as a means of addressing fat resorption. They can be separated from the lipoaspirate following centrifugation, and enzymatically purified from unwanted debris, with collagenase, forming the stromal vascular fraction. The stromal vascular fraction is then recombined with the graft volume prior to implantation. This novel technique, referred to as “cell-assisted lipotransfer”, has shown promising results in terms of reducing fat resorption. These results are due to the pro-angiogenic and pro-adipogenic ability of the stem cells, which allow the graft to address the conditions of ischemia more effectively than autologous fat transfer.The aim of this review is to explore the ways in which cell-assisted lipotransfer is different from the autologous fat transfer, as well as how and why adipose-derived stem cells may contribute towards limiting fat resorption. The immunological background of these cells is discussed in detail, while grounds for further development are discussed, by means of the administration of external growth factors, which could, potentially, maximize outcomes, while limiting complications.

Highlights

BackgroundAutologous fat transfer and cell-assisted lipotransferBreast Augmentation SurgeryBreast augmentation is among the leading types of cosmetic surgical procedures in the United States, with 299,715 procedures in 2019 and 193,073 in 2020 [1]
The aim of this review is to explore the ways in which cell-assisted lipotransfer is different from the autologous fat transfer, as well as how and why adipose-derived stem cells may contribute towards limiting fat resorption
The usefulness of adipose-derived stem cells (ADSCs) in lipotransfer is explored in detail throughout this review, in the context of their pro-angiogenic and pro-adipogenic profile, which has been shown to improve fat graft viability following implantation in the patient

Summary

Introduction

Breast augmentation is among the leading types of cosmetic surgical procedures in the United States, with 299,715 procedures in 2019 and 193,073 in 2020 [1]. The usefulness of ADSCs in lipotransfer is explored in detail throughout this review, in the context of their pro-angiogenic and pro-adipogenic profile, which has been shown to improve fat graft viability following implantation in the patient This novel technique has been shown to be effective for volume increase and breast contour reshaping [8-10], without the invasive nature of breast implantation [4]. Additional evidence has been provided by Gentile et al, who performed histological analysis of 46 patients’ fat grafts prior to implantation for breast augmentation, showing elevated concentrations of ADSCs in the group treated with SVF, compared to the control group [36]. This may be an additional explanation for higher complication rates in CAL vs AFT This finding is in parallel with the paper of Eto et al [18] with regards to the three concentric layers of the fat graft, highlighting the importance of the ratio of surface area to volume [38]. These risks need to be investigated further, as short and long-term patient safety remains of utmost importance at all times

Conclusions

Disclosures

Findings

54. Alexander RW