The Role of Autologous Fat Grafting in Secondary Microsurgical Breast Reconstruction

Weichman, Katie E.; Broer, P. Niclas; Tanna, Neil; Wilson, Stelios C.; Allan, A.; Levine, Jamie P.; Ahn, Christina Y.; Choi, Mihye; Karp, Nolan S.; Allen, Robert J.

doi:10.1097/sap.0b013e3182920ad0

Cited by 43 publications

(28 citation statements)

References 22 publications

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“…As breast cancer remains the most common type of cancer in women, new techniques for postsurgical breast reconstruction constantly develop. Such new procedures to improve autologous fat grafting rely on the enrichment with autologous SVF, platelet-derived growth factors, hormones and/or insulin [27,28]. The reported improvement of fat graft viability with these techniques likely depends on the presence of ADSCs in the SVF.…”

Section: Mesodermal Potential Of Adipose Tissue-derived Stem Cellsmentioning

confidence: 99%

Adipose Tissue-Derived Stem Cells in Regenerative Medicine

Frese

Dijkman

Hoerstrup

2016

Transfus Med Hemother

346

245

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In regenerative medicine, adult stem cells are the most promising cell types for cell-based therapies. As a new source for multipotent stem cells, human adipose tissue has been introduced. These so called adipose tissue-derived stem cells (ADSCs) are considered to be ideal for application in regenerative therapies. Their main advantage over mesenchymal stem cells derived from other sources, e.g. from bone marrow, is that they can be easily and repeatable harvested using minimally invasive techniques with low morbidity. ADSCs are multipotent and can differentiate into various cell types of the tri-germ lineages, including e.g. osteocytes, adipocytes, neural cells, vascular endothelial cells, cardiomyocytes, pancreatic β-cells, and hepatocytes. Interestingly, ADSCs are characterized by immunosuppressive properties and low immunogenicity. Their secretion of trophic factors enforces the therapeutic and regenerative outcome in a wide range of applications. Taken together, these particular attributes of ADSCs make them highly relevant for clinical applications. Consequently, the therapeutic potential of ADSCs is enormous. Therefore, this review will provide a brief overview of the possible therapeutic applications of ADSCs with regard to their differentiation potential into the tri-germ lineages. Moreover, the relevant advancements made in the field, regulatory aspects as well as other challenges and obstacles will be highlighted.

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Section: Mesodermal Potential Of Adipose Tissue-derived Stem Cellsmentioning

confidence: 99%

Adipose Tissue-Derived Stem Cells in Regenerative Medicine

Frese

Dijkman

Hoerstrup

2016

Transfus Med Hemother

346

245

View full text Add to dashboard Cite

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“…Recently, plastic surgery procedures for the treatment of deformities following breast cancer or tissue defects include autologous fat grafting with or without the enrichment with enzimatically-obtained stromal vascular fraction (SVF), platelet-derived growth factors and hormones including insulin [2,3]. Ameliorated transplanted fat viability is critically regulated by the presence of resident adipose derived-stem cells (ASCs).…”

mentioning

confidence: 99%

Adipose Tissue-Derived Stem Cell Therapy for Post-Surgical Breast Reconstruction - More Light than Shadows

Bielli¹,

Gentile²,

Cervelli³

et al. 2015

Adv Clin Exp Med

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Breast cancer remains the most common tumor in women, and new techniques for post-surgical breast reconstruction have been recently introduced. These new procedures include autologous fat grafting with or without the enrichment with autologous stromal vascular fraction (SVF), platelet-derived growth factors and insulin. The reported improvement of fat graft viability with these techniques likely depends on the presence in the SVF of multipotent resident adipose derived-stem cells (ASCs). The clinical advantage derives from the plasticity of ASCs and their ability to generate new functional adipose tissue and vessels. However, there is an ongoing debate regarding the possible interplay between breast tumor cells and resident or transplanted ASCs for their capacity to locally secrete growth factors. Most of the data in the literature concerning ASCs is derived from in vitro models, whereas the knowledge of ASC behavior in vivo remains scarce. Recent reports concerning SVF/ASC enrichment of fat graft did not describe any significant worsening of prognosis for patients undergoing those procedures. However, further studies and longer follow-ups are needed to specifically define technical procedures and to confirm the safety of procedures of SVF/ASC enrichment during post-surgical breast reconstruction (Adv Clin Exp Med 2015, 24, 3, 545-548).

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“…En los casos de MS-TRAM (Muscle Sparing Free Transverse Abdominus Myocutaneous Flap), nuestra tendencia es a la mínima resección de la lámina anterior de la fascia de los rectos para permitir el cierre primario y la máxima preservación muscular, que se ha relacionado con disfuncionalidad postquirúrgica de la pared abdominal (15,16). El injerto de grasa autóloga nos ha permitido mejorar el contorno en irregularidades o aumentar el volumen en pacientes con bajo índice de masa corporal y colgajos pequeños (12). A pesar de no haber hallado una asociación entre la existencia de complicaciones y la mayor necesidad de cirugías secundarias, el relleno con grasa autóloga se empleó en el 48,4% de nuestras pacientes, principalmente para corregir irregularidades en las zonas de transición del colgajo con el lecho de mastectomía.…”

Section: Discussionunclassified

“…En ocasiones se necesitan procedimientos secundarios adicionales para mejorar el resultado estético de la reconstrucción. A pesar de que la existencia de estas cirugías de retoque ha sido señalada en varios artículos (8)(9)(10)(11)(12), no hay información detallada de cuáles son los procedimientos más empleados, ni de la relación entre factores relacionados con la reconstrucción y la cantidad de cirugías necesarias para completarla.…”

Section: Introductionunclassified

Factores relacionados con la cirugía secundaria en la reconstrucción mamaria autóloga con tejido libre abdominal

Hernández-Godoy

Landín

Garcia-Redondo

et al. 2015

Cir. plást. iberolatinoam.

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ResumenLa reconstrucción mamaria con colgajo libre abdominal se ha convertido en la opción terapéutica de elección en nuestro centro hospitalario cuando se necesita abundante cantidad de tejido. La culminación de este tipo de reconstrucción requiere un número variable de procedimientos auxiliares de retoque.Revisamos las historias de las pacientes sometidas en nuestro centro a reconstrucción mamaria con colgajo libre abdominal entre enero de 2010 y diciembre de 2013. El criterio de inclusión fue la reconstrucción del pezón como última cirugía. Las pacientes fueron estratificadas atendiendo a factores relacionados con la reconstrucción microquirúrgica y la existencia de radioterapia adyuvante. Analizamos el número y tipo de procedimientos y cirugías de retoque, así como el tiempo transcurrido hasta completar el proceso de reconstrucción.En total, recogimos 68 pacientes reconstruidas con colgajo libre abdominal. De ellas, 31 (45,6%) completaron la reconstrucción mamaria. La media de procedimientos fue de 3,2 por paciente, con una media de 2,4 tiempos quirúrgicos y un tiempo medio de 15,5 meses hasta la reconstrucción del pezón. El momento de la reconstrucción, la bilateralidad, el tratamiento con radioterapia y la presencia de complicaciones tempranas del colgajo no se relacionaron con diferencias estadísticamente significativas en la tasa de cirugía secundaria.Los colgajos libres abdominales necesitan frecuentemente cirugías secundarias para mejorar el resultado y terminar la reconstrucción. Remarcamos la necesidad de planificar la reconstrucción desde el primer tiempo quirúrgico para disminuir la necesidad de cirugías de retoque y el tiempo hasta completar la reconstrucción mamaria.Palabras clave Reconstrucción mamaria, Colgajo libre abdominal, Cirugía secundaria. Nivel de evidencia científica 4 AbstractBreast reconstruction using abdominal free flaps has become the therapeutic choice at our center when a lot of tissue is needed, The completion of this reconstructive technique requires a variable number of ancillary procedures.Patients who underwent breast reconstruction with abdominal free flap at our center between January 2010 and December 2013 were reviewed. The inclusion criterion was completion to nipple reconstruction. The patients were stratified attending to microsurgical reconstruction related factors and adjuvant radiotherapy. Number and sort of procedures and surgeries, and total elapsed time to complete the reconstruction were analyzed.Sixty-eight patients underwent reconstruction using abdominal free flap; 31 (45.6%) completed breast reconstruction. The average of procedures, surgical steps and elapsed time was 3.2, 2.4 and 15.5 months respectively. Surgical time and bilateral procedures, treatment with radiotherapy and early flap complications were not related to statistically significant differences in secondary surgery rates.Abdominal free flaps often need secondary surgeries to improve the result and finish the reconstruction. We remark the necessity of planning the reconstruction since first s...

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The Role of Autologous Fat Grafting in Secondary Microsurgical Breast Reconstruction

Cited by 43 publications

References 22 publications

Adipose Tissue-Derived Stem Cells in Regenerative Medicine

Adipose Tissue-Derived Stem Cells in Regenerative Medicine

Adipose Tissue-Derived Stem Cell Therapy for Post-Surgical Breast Reconstruction - More Light than Shadows

Factores relacionados con la cirugía secundaria en la reconstrucción mamaria autóloga con tejido libre abdominal

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