Abstract
The areas in which Stromal Vascular Fraction cells (SVFs) have been used include radiotherapy based tissue damage after mastectomy, breast augmentation, calvarial defects, Crohn’s fistulas, and damaged skeletal muscle. Currently, the authors present their experience using regenerative cell therapy in breast reconstruction. The goal of this study was to evaluate the safety and efficacy of the use of Engineered Fat Graft Enhanced with Adipose-derived Stromal Vascular Fraction cells (EF-e-A) in breast reconstruction. 121 patients that were affected by the outcomes of breast oncoplastic surgery were treated with EF-e-A, comparing the results with the control group (n = 50) treated with not enhanced fat graft (EF-ne-A). The preoperative evaluation included a complete clinical examination, a photographic assessment, biopsy, magnetic resonance (MRI) of the soft tissue, and ultrasound (US). Postoperative follow-up took place at two, seven, 15, 21, 36 weeks, and then annually. In 72.8% (n = 88) of breast reconstruction treated with EF-e-A, we observed a restoration of the breast contour and an increase of 12.8 mm in the three-dimensional volume after 12 weeks, which was only observed in 27.3% (n = 33) of patients in the control group that was treated with EF-ne-A. Transplanted fat tissue reabsorption was analyzed with instrumental MRI and US. Volumetric persistence in the study group was higher (70.8%) than that in the control group (41.4%) (p < 0.0001 vs. control group). The use of EF-e-A was safe and effective in this series of treated cases.
Highlights
The popularization of the fat grafting concept has resulted in greater patient demand for breast augmentation that is based on Engineered Fat Graft Enhanced with Adipose-derived Stromal Vascular Fraction cells (EF-e-A) concept
These cells can be further purified while using a combination of washing steps and culture expansion, with media that are similar to the ones used for bone marrow MSCs, in order to deplete most of the hematopoietic cell population from the Stromal Vascular Fraction (SVF) cells and differentiate them into classical mesodermal tissues after isolation and under specific stimuli [4,5]
Between January 2008 and June 2015, 121 consecutive patients (SG) diagnosed with outcomes of breast cancer, previously undergoing oncoplastic reconstructive surgery (81 patients affected by the outcomes of mastectomy, 21 patients with outcomes of quadrantectomy, and 19 patients with outcomes of breast reconstruction performed with prosthesis) were treated with EF-e-A for breast reconstruction at the Unit of Breast Surgery of the University of Florence, Italy
Summary
The popularization of the fat grafting concept has resulted in greater patient demand for breast augmentation that is based on Engineered Fat Graft Enhanced with Adipose-derived Stromal Vascular Fraction cells (EF-e-A) concept. When the Stromal Vascular Fraction cells (SVFs) are seeded into a culture, a subset of elongated cells begins to adhere to the tissue culture plastic ware These cells can be further purified while using a combination of washing steps and culture expansion, with media that are similar to the ones used for bone marrow MSCs, in order to deplete most of the hematopoietic cell population from the SVF cells and differentiate them into classical mesodermal tissues (like bone, fat, and cartilage) after isolation and under specific stimuli [4,5]. They can further hold clinical potential in relation to osteogenesis [6], vasculogenesis [7], and other neuronal repair models [8]
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