By Joel A. Aronowitz, MD
Clinical Professor Plastic Surgery
USC Keck School of Medicine
Cedars Sinai Medical Center
University Stem Cell Center
Our fat tissue contains a lot more than just fat. It’s been known for many years that the fat that makes our jeans tight and skin loose contains large numbers of small cells with the potential to grow into many types of the tissue and play a central role in healing and regeneration. Only recently though have doctors been able to apply these exciting laboratory findings to help patients in clinical practice.
A study underway by doctors at the Breast Preservation Foundation in Los Angeles exemplifies this new trend in clinical use of Adipose Derived Stem Cell. Women in the study are offered use of their own stem cells to regrow their breast marred by prior surgery and even radiation to treat breast cancer.
Treatment of breast cancer usually involves removal of the tumor itself along with all or part of the surrounding normal breast to ensure that a complete removal is accomplished. After the surgery, the breast is frequently treated with radiation which further shrinks the breast and turns the soft breast tissue to a hard, woody texture. For years, the only options available to reconstruct the breast were highly invasive flap procedures such as the lat dorsi or TRAM flaps or an implant. The flaps require a donor site scar and extended healing, and implants are associated with the problems of any large foreign body. They are especially problematic after radiation treatment.
Stem cell treatment has the advantage of producing a natural regrowth of fat tissue within the breast, giving it a soft, natural appearance and feel using the woman’s own fat stored in the abdomen, hips and thighs. The Los Angeles study uses fat harvested with liposuction from the hip, abdomen or thighs. The fat, usually 400 to 600 cc, is treated in a special biologic laboratory right in the operating room to isolate the tiny stem cells from the larger mature adipocyte (fat) cells and other components in the lipoaspirate (obtained during liposuction). The process takes about 1.5 hours while the patient remains in the operating room. The tedious process involves a complex series of washings and high-speed centrifugations but no additional chemicals or growth factors are added to change the biology or genetics of the cells.
Almost a million cells on average are isolated from each 1 cc drop of liposuction fat. The stem cells are then added to additional lipoaspirate to inject into the disfigured breast. The stem-cell-enhanced fat grafts are placed with a blunt hollow needle in small aliquots so no surgical scars are placed on the treated breasts. Postoperative healing is usually limited to swelling and bruising both in the breast and the liposuction harvest area. Patients usually complain of more discomfort in the liposuction areas then the treated breast. Of course, no one complains about the improved contour of the hips and abdomen which comes with the needed liposuction; it’s an added bonus.
Improved breast size is immediate, but the improved skin quality and regeneration or regrowth of fat takes about 3 to 6 months as the larger fat cells that do not survive the transfer process are replaced by new tissue regenerated by the large numbers of tiny stem cells. Improvement in the texture, quality and skin color of the breast damaged by surgery and radiation begins immediately and begins to show clinically in about 2 months.
Women who have a breast damaged by breast cancer treatment, especially lumpectomy and radiation are generally good candidates for this treatment. The study requires a waiting period after cancer treatment, but some doctors feel that soon the treatment will be offered in concert with cancer treatment as there is no evidence that normal fat-derived stem cells interfere with treatment. Women seeking an alternative to breast enlargement with implants will be happy to know that this option is available to them as well. Stem-cell-enhanced fat grafting can produce about 1 to 2 cup sizes of enlargement on average and can be repeated every 3-4 months as long as sufficient donor fat is available.