Can Stem Cells Improve the Results of Fat Transfer Augmentation?

by Dr. David Sayah

The plastic surgery field is constantly looking for better ways to enhance the body while improving the patient experience. Autologous fat grafting in breast reconstruction is one example of trying new approaches for beautiful results. Yet, despite the potential benefits, using fat transfer in breast augmentation doesn’t always deliver consistent results; surgeons have reported resorption rates as high as 80 percent. A new study indicates that using stem cells during breast reconstruction could improve the process of autologous fat grafting.

Challenges in Reconstruction Augmentation
Breast reconstruction is regarded as one of the more challenging plastic surgeries. There are significant cosmetic limitations due to existing scar and glandular tissue, even if plastic surgeons are included at the outset of treatment. Typically, breast implants alone simply are not enough to craft the beautiful, natural results that patients and surgeons alike hold as a goal for successful reconstructive surgery. Without sufficient tissue coverage, implants may remain palpable or edges may remain visible.

Autologous tissue reconstruction provides an alternative that looks and feels more natural, either with or without the addition of synthetic implants. Flap reconstruction transfers tissue from a donor site in either the abdomen or posterior shoulder, which is then reshaped into a viable breast. Implants may form the foundation of flap reconstruction, or the tissue alone may be used to provide sufficient shape and form. However, autograft reconstruction is a lengthy and challenging surgery; not every patient is a good candidate.

Allogeneic dermal grafts offer another alternative for reconstruction. This approach is more technically difficult than implants from a surgical perspective, resulting in a lengthier surgery that is also more expensive. Like autologous tissue reconstruction, allograft reconstruction can be performed with or without the inclusion of implants. Implant reconstruction remains the fastest and most popular route for reconstruction, even when taking into account the limitations involved.

Autologous fat transfer may be incorporated along with implants for fine tuning around visible implant edges, or to ensure a more even look. Yet, unpredictable resorption rates and variances in harvesting techniques combine to undermine the reliability of autologous fat transfer alone for either breast reconstruction or cosmetic augmentation.

Refining Techniques
Stem cells offer new possibilities across numerous medical fields, from arthritis treatments to plastic surgery. Adult stem cells have a high concentration in adipose tissue, and possess the unique capability to adapt to other cell types. They promote healing as part of the body’s natural inflammation response; when used in surgery, the normal healing process triggers stem cell division and growth.

A new research study reports results from 10 study participants who underwent liposuction followed by fat grafts. Two purified fat grafts were taken from each participant; one of these was enriched with adipose stem cells and the non-enriched graft served as a control. After subcutaneous injection, the fat graft volumes were immediately measured by MRI, and then were measured a second time four months later. Findings showed that the residual ASC-enriched fat graft volumes were 64.6 percent higher than the control grafts.

Future Implications
With the high safety levels of this procedure (there were no significant adverse effects noted), stem cell-enriched fat grafting shows promising results, and could lead to an increased use of stem cells in clinical settings. If enrichment with stem cells upholds lipofilling as a serious contender against major tissue augmentation with allogeneic material, the face of reconstructive surgery and cosmetic surgery could drastically change.