Advertisement

Stem cell enrichment does not warrant a higher graft survival in lipofilling of the breast: A prospective comparative study

      Summary

      Background

      Stem cell enrichment is generally believed to be of crucial importance for success in lipofilling for cosmetic breast augmentation. No comparative clinical studies have been reported to support this.

      Methods

      A total of 18 women underwent breast augmentation with water-assisted lipotransfer (WAL). In 10 of the cases, transferred lipoaspirate was enriched with stromal stem cells using the Celution® system (Cytori Therapeutics Inc., San Diego, Ca, USA). Magnetic resonance imaging (MRI)-based volumetric analysis was done preoperatively and 6 months after the procedure. To verify scientifically that stem cells were transplanted, samples of the transplanted tissues were processed in the laboratory to isolate the adipose stem cells (ASCs).

      Results

      MRI volumetry revealed a volume survival of the whole (watery) graft of mean 54% (SD 7) in the WAL only and of 50% (SD 10) in the WAL with stem cell-enrichment patients. As centrifugation of the WAL grafts demonstrated an average adipose tissue of 68%, the average volume survival of adipose tissue itself was 79% (SD 13) in the WAL only and 74% (SD 14) in the WAL with stem cell-enrichment patients. This difference (4.5%) was not statistically significant (independent samples t test, p = 0.330, 95% confidence interval of difference, 4.8, 13.9%).

      Conclusions

      Breast augmentation by lipofilling using WAL alone is faster, cheaper, has a lower risk of contamination and offers at least an equal take rate. We do not see any advantage in stem cell enrichment by the Celution® system in cosmetic fat transplantation to the breast.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Illouz Y.G.
        • Sterodimas A.
        Autologous fat transplantation to the breast: a personal technique with 25 years of experience.
        Aesthetic Plast Surg. 2009; 33: 706-715
        • Bircoll M.
        • Novack B.H.
        Autologous fat transplantation employing liposuction techniques.
        Ann Plast Surg. 1987; 18: 327-329
        • Coleman S.
        Augmentation of the breast with structural fat.
        in: Coleman S.R. Mazzola R.F. Fat injection from filling to regeneration quality. Medical Publishing Inc, St Louis, MI2009
        • Coleman S.R.
        • Saboeiro A.P.
        Fat grafting to the breast revisited: safety and efficacy.
        Plast Reconstr Surg. 2007; 119 ([discussion 86–7]): 775-785
        • Khouri R.K.
        • Eisenmann-Klein M.
        • Cardoso E.
        • et al.
        Brava® and autologous fat transfer is a safe and effective breast augmentation alternative: results of a six-year, eighty-one patients prospective multicenter study.
        Plast Reconstr Surg. 2012; 129: 1173-1187
        • Shippert R.
        Autologous fat transfer: eliminating the centrifuge, decreasing lipocyte trauma and establishing standardization for scientific study.
        Am J Cosmet Surg. 2006; 23: 21-27
        • Ferguson R.E.
        • Cui X.
        • Fink B.F.
        • Vasconez H.C.
        • Pu L.L.
        The viability of autologous fat grafts harvested with the LipiVage system: a comparative study.
        Ann Plast Surg. 2008; 60: 594-597
        • Sasaki G.H.
        Water-assisted liposuction for body contouring and lipoharvesting: safety and efficacy in 41 consecutive patients.
        Aesthet Surg J. 2011; 31: 76-88
        • Aust L.
        • Devlin B.
        • Foster S.J.
        • et al.
        Yield of human adipose-derived adult stem cells from liposuction aspirates.
        Cytotherapy. 2004; 6: 7-14
        • Eto H.
        • Suga H.
        • Matsumoto D.
        • et al.
        Characterization of structure and cellular components of aspirated and excised adipose tissue.
        Plast Reconstr Surg. 2009; 124: 1087-1097
        • Yoshimura K.
        • Sato K.
        • Aoi N.
        • et al.
        Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells.
        Aesthetic Plast Surg. 2008; 32 ([discussion 56–7]): 48-55
        • Tiryaki T.
        • Findikli N.
        • Tiryaki D.
        Staged stem cell-enriched tissue (SET) injections for soft tissue augmentation in hostile recipient areas: a preliminary report.
        Aesthetic Plast Surg. 2011; 35: 965-971
        • Smith P.
        • Adams Jr., W.P.
        • Lipschitz A.H.
        • et al.
        Autologous human fat grafting: effect of harvesting and preparation techniques on adipocyte graft survival.
        Plast Reconstr Surg. 2006; 117: 1836-1844
        • Herold C.
        • Pflaum M.
        • Utz P.
        • et al.
        Viability of autologous fat grafts harvested with the Coleman technique and the Tissu Trans system (Shippert method): a comparative study.
        Handchir Mikrochir Plast Chir. 2011; 43: 361-367
        • Alexander Del Vecchio D.
        • Bucky L.P.
        Breast augmentation using pre-expansion and autologous fat transplantation – a clinical radiological study.
        Plast Reconstr Surg. 2011; 27: 2441-2450
        • Herold C.
        • Ueberreiter K.
        • Cromme F.
        • Busche M.N.
        • Vogt P.M.
        The use of mamma MRI volumetry to evaluate the rate of fat survival after autologous lipotransfer.
        Handchir Mikrochir Plast Chir. 2010; 42: 129-134
        • Ueberreiter K.
        BEAULI™ – eine neue Methode zur einfachen und zuverlässigen Fettzell- Transplantation.
        Handchir Mikrochir Plast Chir. 2010; 42: 379-385
        • Herold C.
        • Knobloch K.
        • Rennekampff H.O.
        • Ueberreiter K.
        • Vogt P.M.
        Magnetic resonance imaging-based progress control after autologous fat transplantation.
        Plast Reconstr Surg. 2010; 126: 260e-261e
        • Henseler H.
        • Khambay B.S.
        • Bowman A.
        • et al.
        Investigation into accuracy and reproducibility of a 3D breast imaging system using multiple stereo cameras.
        J Plast Reconstr Aesthet Surg. 2011; 64: 577-582
        • Zuk P.A.
        • Zhu M.
        • Mizuno H.
        • et al.
        Multilineage cells from human adipose tissue: implications for cell-based therapies.
        Tissue Eng. 2001; 7: 211-228
        • Lin K.
        • Matsubara Y.
        • Masuda Y.
        • et al.
        Characterization of adipose tissue-derived cells isolated with the Celution system.
        Cytotherapy. 2008; 10: 417-426
        • Lindroos B.
        • Boucher S.
        • Chase L.
        • et al.
        Serum-free, xeno-free culture media maintain the proliferation rate and multipotentiality of adipose stem cells in vitro.
        Cytotherapy. 2009; 11: 958-972
        • Dominici M.
        • Le Blanc K.
        • Mueller I.
        • et al.
        Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement.
        Cytotherapy. 2006; 8: 315-317
        • Lindroos B.
        • Aho K.L.
        • Kuokkanen H.
        • et al.
        Differential gene expression in adipose stem cells cultured in allogeneic human serum versus fetal bovine serum.
        Tissue Eng Part A. 2010; 16: 2281-2294
        • Yoshimura K.
        • Asano Y.
        • Aoi N.
        • et al.
        Progenitor-enriched adipose tissue transplantation as rescue for breast implant complications.
        Breast J. 2009; 16: 169-175
        • Suga H.
        • Eto H.
        • Aoi N.
        • et al.
        Adipose tissue remodeling under ischemia: death of adipocytes and activation of stem/progenitor cells.
        Plast Reconstr Surg. 2010; 126: 1911-1923
        • Schreml S.
        • Babilas P.
        • Fruth S.
        • et al.
        Harvesting human adipose tissue-derived adult stem cells: resection versus liposuction.
        Cytotherapy. 2009; 11: 947-957
        • Rigotti G.
        • Marchi A.
        • Galie M.
        • et al.
        Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells.
        Plast Reconstr Surg. 2007; 119 ([discussion 23–4]): 1409-1422
        • Herold C.
        • Rennekampff H.O.
        • Kramer R.
        • et al.
        Stem cell-enhanced fat transplantation – a potential therapeutic option for radiation ulcus?.
        Zentralbl Chir. 2013; 138: 164-165
        • Moseley T.A.
        • Zhu M.
        • Hedrick M.H.
        Adipose-derived stem and progenitor cells as fillers in plastic and reconstructive surgery.
        Plast Reconstr Surg. 2006; 118: 121-128
        • Zhu M.
        • Zhou Z.
        • Chen Y.
        • et al.
        Supplementation of fat grafts with adipose-derived regenerative cells improves long-term graft retention.
        Ann Plast Surg. 2010; 64: 222-228
        • Matsumoto D.
        • Sato K.
        • Gonda K.
        • et al.
        Cell-assisted lipotransfer: supportive use of human adipose-derived cells for soft tissue augmentation with lipoinjection.
        Tissue Eng. 2006; 12: 3375-3382
        • Rose Jr., J.G.
        • Lucarelli M.J.
        • Lemke B.N.
        • et al.
        Histologic comparison of autologous fat processing methods.
        Ophthal Plast Reconstr Surg. 2006; 22: 195-200
        • Eto H.
        • Kato H.
        • Suga H.
        • et al.
        The fate of adipocytes after nonvascularized fat grafting: evidence of early death and replacement of adipocytes.
        Plast Reconstr Surg. 2012; 129: 1081-1092
        • Keck M.
        • Zeyda M.
        • Gollinger K.
        • et al.
        Local anesthetics have a major impact on viability of preadipocytes and their differentiation to adipocytes.
        Plast Reconstr Surg. 2010; 126: 1500-1505
        • Araco A.
        • Gravante G.
        • Araco F.
        • Delogu D.
        • Cervelli V.
        Comparison of power water-assisted and traditional liposuction: a prospective randomized trial of postoperative pain.
        Aesthetic Plast Surg. 2007; 31: 259-265
        • Prantl L.
        • Muehlberg F.
        • Navone N.M.
        • et al.
        Adipose tissue-derived stem cells promote prostate tumor growth.
        Prostate. 2010; 70: 1709-1715
        • Zimmerlin L.
        • Donnenberg A.D.
        • Rubin J.P.
        • et al.
        Regenerative therapy and cancer: in vitro and in vivo studies of the interaction between adipose-derived stem cells and breast cancer cells from clinical isolates.
        Tissue Eng Part A. 2010; 17: 93-106
        • Kim M.
        • Kim I.
        • Lee S.K.
        • Bang S.I.
        • Lim S.Y.
        Clinical trial of autologous differentiated adipocytes from stem cells derived from human adipose tissue.
        Dermatol Surg. 2011; 37: 750-759
        • Herold C.
        • Reichelt A.
        • Stieglitz L.H.
        • et al.
        MRI-based breast volumetry-evaluation of three different software solutions.
        J Digit Imaging. 2010; 23: 603-610