Cell-enriched Procedure for Breast Reconstruction Comes to SA
BY CLAIRE SMITH ON NOVEMBER 7, 2011 (Medical Chronicle)

Two SA patients have become the first recipients of a ground-breaking cosmetic and reconstructive surgery procedure in which patients’ fat is enriched with their own adipose-derived stem and regenerative cells (ADRCs) to create a cell-enriched fat, which is then grafted back into the body.

In breast reconstruction following cancer, the technique has been shown to be vastly more successful than conventional fat grafting (lipomodeling), which typically drains by between 20%-40%. The technique necessitates, on average, three repeat procedures, especially if the patient also undergoes radiation therapy.

Cell-enriched breast reconstruction utilises the body’s own fat, enriched with adult adipose-derived stem and regenerative cells (ADRCs), to rebuild the breast’s contour following breast cancer surgery. Fat is withdrawn via liposuction from the stomach, hips, thighs, or other areas determined to provide the necessary tissue. A portion of this tissue is processed to extract stem and regenerative cells that naturally reside within the tissue. The cells are then combined with another sample of fat, forming a cell-enriched fat graft, which is used to correct breast defects or asymmetry.

With improvements in cancer treatments, lumpectomies are increasingly favoured as a less invasive alternative to full mastectomies. However, reconstruction to improve breast contour is often a challenge.

High Survial Rate

"ADRC-enriched fat grafting offers a far higher graft survival rate, as the live stem cells improve blood supply and bring the necessary oxygen and nutrients to the transplant area, which protects the fat from dying and minimises inflammatory reaction,” explained Christopher Calhoun, CEO of Cytori Therapeutics, manufacturers of The Celution® System family of medical devices and instruments.

“The new procedure not only offers a far more natural and symmetrical outcome, but also helps the body to heal, rather than scar,” he said. The operations were performed at the Tygerburg Hospital in Cape Town, on 18 October.

The first patient, a 50 year old woman, underwent treatment for an upper and lower blepharoplasty, lipofilling for facial rejuvenation and lipofilling to improve her right breast after mastectomy and reconstruction. Another cell-enriched procedure offered an aesthetic improvement to a 40 year old woman, who was left with a defect and radiation damage in the left parotid area after parotid gland carcinoma resection and radiotherapy six years ago.

Prof Frank Graewe, chairman and professor of the department of plastic and reconstructive surgery, University of Stellenbosch, Tygerberg Hospital, who also runs a private practice, carried out the surgeries together with US surgeon, Dr Jeffrey Hartog, who has been performing cell enriched fat grafts for more than a year in that country.

“The use of these cells at this stage is limited to promote healing in difficult environments, such as in previously irradiated tissue,” said Prof Graewe. “However, it can also be used as an adjunct in lipofilling for cosmetic purposes to improve graft take.” He added: “Plastic surgery is an innovative specialty, and many new techniques and inventions were originally performed by plastic surgeons. One such example is Botulinum toxin, which revolutionised facial rejuvenation.

The Next Big Thing

I think fat is the next big thing, not only in plastic surgery, but also in numerous other medical areas. Research showed that there are a hundred-fold more stem cells locked into adipose tissue than bone marrow.

”He believes the ADRC-enriched fat grafting technique, which he describes as ‘relatively easy to use’, will be made available for a multitude of new therapeutic applications in the future. Prof Graewe added, “I am glad that we could host a historical workshop like this at our plastic surgery unit at Tygerberg Hospital and get some first-hand experience.” He believes that as the first commercially available technology to extract regenerative cells and adult stem cells from liposuction aspirate, the procedure will receive attention at the first meeting of the International Society of Plastic Regenerative Surgery, in March 2012 in Rome.

Several clinical studies have demonstrated the success of the technique, which has been carried out on some 4000 patients worldwide. RESTORE I examined reconstruction of partial mastectomy breast defects using ADRCs. The technique was found to be safe and well tolerated in all patients, and showed a high level of patient satisfaction (79%). RESTORE 2, reinforced the safety of the procedure, and reported 73% of patients and 82% of physicians as being satisfied with the outcome of the procedure.