Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells

Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
Aesthetic Plastic Surgery (Impact Factor: 0.96). 02/2008; 32(1):48-55; discussion 56-7. DOI: 10.1007/s00266-007-9019-4
Source: PubMed


Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis.
To overcome the problems with lipoinjection, the authors developed a novel strategy known as cell-assisted lipotransfer (CAL). In CAL, autologous adipose-derived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation.
Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation.
The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.

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    • "While facial lipoatrophy can be addressed by grafting as low as 10–20 mL of fat tissue, breast augmentation procedures might require up to 200–300 mL of the fat graft for a single breast [11] [12] [13]. Although the ratio of SVF to be supplemented to a given volume of fat graft has still not been systematically studied in humans, supplementation of SVF recovered from a corresponding volume of fat tissue has been widely reported to be safe and provides favorable clinical outcomes [11] [12] [13] [14] [15] [16]. "
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    ABSTRACT: Autologous fat grafting for soft tissue reconstruction is challenged by unpredictable long-term graft survival. Fat derived stromal vascular fraction (SVF) is gaining popularity in tissue reconstruction as SVF-enriched fat grafts demonstrate improved engraftment. SVF also has potential in regenerative medicine for remodeling of ischemic tissues by promoting angiogenesis. Since SVF cells do not require culture expansion, attempts are being made to develop automated devices to isolate SVF at the point of care. We report development of a closed, automated system to process up to 500 mL lipoaspirate using cell size-dependent filtration technology. The yield of SVF obtained by automated tissue digestion and filtration (1.17 ± 0.5 × 10 5 cells/gram) was equivalent to that obtained by manual isolation (1.15 ± 0.3 × 10 5 ; p = 0.8), and the viability of the cells isolated by both methods was greater than 90%. Cell composition included CD34+CD31− adipose stromal cells, CD34+CD31+ endothelial progenitor cells, and CD34−CD31+ endothelial cells, and their relative percentages were equivalent to SVF isolated by the manual method. CFU-F capacity and expression of angiogenic factors were also comparable with the manual method, establishing proof-of-concept for fully automated SVF isolation, suitable for use in reconstructive surgeries and regenerative medicine applications.
    Full-text · Article · Jul 2015 · Stem cell International
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    • "The estimated survival rate of transplanted adipocytes is reported to be approximately 30e40% [3]. To resolve this problem, many approaches have been investigated [1] [7] [8]. We previously reported that in the process of engraftment of transplanted adipocytes, the adipocyte not only waits to be vascularized from the graft bed but also actively ameliorates the surrounding environment [9]. "
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    ABSTRACT: Poor survival is a major problem of adipocyte transplantation. We previously reported that VEGF and MMPs secreted from transplanted adipocytes are essential for angiogenesis and adipogenesis. Pretreatment with low-dose (5 Gy) radiation (LDR) increased VEGF, MMP-2, and HIF-1 alpha mRNA expression in human ceiling culture-derived proliferative adipocytes (hccdPAs). Gene expression after LDR differed between adipose-derived stem cells (hASCs) and hccdPAs. Pretreatment with LDR improved the survival of hccdPAs under hypoxia, which is inevitable in the early stages after transplantation. Upregulation of VEGF and MMP-2 after LDR in hccdPAs is mediated by HIF-1 alpha expression. Our results suggest that pretreatment with LDR may improve adipocyte graft survival in a clinical setting through upregulation of VEGF and MMP-2 via HIF-1 alpha. Copyright © 2015. Published by Elsevier Inc.
    Preview · Article · Jun 2015 · Biochemical and Biophysical Research Communications
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    • "Of note, the amount of ADSCs in autologous lipotransfers seems to affect the long-term survival of fat grafting (Mojallal et al., 2011; Rodriguez et al., 2004). The use of fat grafts, enriched with autologous isolated ADSCs, has been reported to increase the longevity and the volume of these implants (Yoshimura et al., 2008; Zhu et al., 2010). "
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    ABSTRACT: Nowadays, fat tissue transplantation is widely used in regenerative and reconstructive surgery. However, a shared method of lipoaspirate handling for ensuring a good quality fat transplant has not yet been established. The study was to identify a method to recover from the lipoaspirate samples the highest number of human viable adipose tissue-derived stem cells (hADSCs) included in stromal vascular fraction (SVF) cells and of adipocytes suitable for transplantation, avoiding an extreme handling. We compared the lipoaspirate spontaneous stratification (10-20-30 min) with the centrifugation technique at different speeds (90-400-1500xg). After each procedure, lipoaspirate was separated into top oily lipid layer, liquid fraction, "middle layer" and bottom layer. We assessed the number of both adipocytes in the middle layer and SVF cells in all layers. The histology of middle layer and the surface phenotype of SVF cells by stemness markers (CD105 + , CD90 + , CD45-) were analyzed as well. The results showed a normal architecture in all conditions except for samples centrifuged at 1500xg. In both methods, the flow cytometry analysis showed that greater number of ADSCs was in middle layer; in the fluid portion and in bottom layer was not revealed significant expression levels of stemness markers. Our findings indicate that spontaneous stratification at 20 min and centrifugation at 400xg are efficient approaches to obtain highly viable ADSCs cells and adipocytes, ensuring a good thickness of lipoaspirate for autologous fat transfer. Since an important aspect of surgery practice consists of gain time, the 400xg centrifugation could be the recommended method when the necessary instrumentation is available. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Full-text · Article · Mar 2015 · Journal of Cellular Physiology
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