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

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.

A Closed-system Technology for Mechanical Isolation of High Quantities of Stromal Vascular Fraction from Fat for Immediate Clinical Use

“…To achieve this, a clinical-grade device is in development. Since the SVF cells obtained using the RBs device are similar to the ones obtained by enzymatic extraction, their successful and efficient use is anticipated in various indications in which the clinical efficacy of enzymatically extracted SVF was previously demonstrated such as CAL 30 and for the treatment of osteoarthritis. 16 , 31 Furthermore, the fact that it enables rapid extraction of SVF cells (~15 min) in a closed sterile device provides the RBs technology significant advantages over enzymatic SVF extraction methods for ioSVF use.…”

Activation of moderate autophagy promotes survival of fat graft

“…3,4 Thus, how to reduce the cell death during ischemia and accelerate the process of revascularization is the core problem of current fat grafting research. In the past decade, multiple methods have been confirmed to promote revascularization of fat grafting, such as fat grafting assisted by adipose-derived stem cells (ADSCs), [5][6][7] ADSC-derived culture medium, 8,9 or exosomes, [10][11][12] but few effective methods have been proposed for enhancing the ischemic tolerance of fat grafts.…”