…..Lipoaugmentation of the breast has been controversial, however, due to concerns regarding its interference with mammography and cancer surveillance. We have demonstrated that when compared with a widely accepted surgical procedure of the breast, reduction mammaplasty, lipoaugmentation with autologous stem cell enrichment produces lower rates of radiographic abnormalities and a more favorable Breast Imaging Reporting and Data System score.
There are a number of interesting issues raised by this article. First, what is the ideal control or comparison group? Are patients who have had breast reduction surgery the best control? Second, although multiple radiologic abnormalities are evaluated in this study, the major concern with lipoaugmentation is the development of suspicious calcifications,10,11,14 and more attention could have been focused on that specific question and the almost three-fold higher incidence of this finding in lipoaugmentation patients. Third, the findings of the article raise significant questions as to where the fat is actually injected—that is, around versus into the breast parenchyma. Fourth, the study employs radiologists who are specifically trained in breast imaging, which might not reflect the skill sets of radiologists found at most diagnostic imaging centers across the United States today. In addition, even among this highly trained group of radiologists, intergrader variation was high. Finally, this study uses a lipoaugmentation technique (creating stromally enriched adipose tissue) that is presumed to concentrate stem cells; this protocol is not a widely used method, and it is not relevant to the main objective of the study.
Fat grafting remains one of the most controversial procedures in plastic surgery because there is no standardized technique used by plastic surgeons to harvest, process, and place fat grafts. In addition, and most importantly, how the fat grafts survive after they are transplanted in vivo remains unclear and needs to be determined. The present study was conducted by Dr. Kotaro Yoshimura's group from the University of Tokyo, one of the most active teams in the field of fat grafting and adipose stem/stromal/progenitor cell (adipose-derived stromal cell) research. The study, composed of two parts, is another example of an important and well-conducted study in understanding the mechanism of how fat grafts survive after transplantation. ….. most adipocytes in the graft site begin to die on day 1 and only some of the adipocytes located within 300 μm of the tissue edge would survive. The number of proliferating cells increases from day 3, and increases in viable adipocyte areas can be detected from day 7.
Although the present study is well conducted, with sound and contemporary methodology, I would encourage the authors to perform a long-term in vivo study, such as 2 to 3 months in the same animal model, which may be equivalent to approximately 6 to 12 months in humans..
Fat Injections for Breast Augmentation (November 6, 2008)
Complications After Autologous Fat Injections to the Breast – an Article Review (April 2, 2009)
Recent NPR Stories on Plastic Surgery (June 3, 2009)
ASPS Task Force Updates Position on Fat Grafting (August 13, 2009)
Risks of Fat Grafting in Breast Cancer Patients (November 22, 2010)
Update: Stem Cells and Fat Grafting (May 11, 2011)