Benefits of Stem Cell Breast Reconstruction
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Benefits of Stem Cell Breast Reconstruction
By Joel A. Aronowitz, MD
Clinical Professor Plastic Surgery
USC Keck School of Medicine
Cedars Sinai Medical Center
University Stem Cell Center
Added to Articles on Thu 12/15/2011
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.
Suzanne Somers and the Future of Breast Reconstruction
Suzanne Somers is famous for her alternative approach to health. So when she lost most of one breast to cancer 10 years ago, she wasn't about to settle for just any old implant. Here, the story of how she waited for — and got — the breast she'd always wanted.
By Allison Takeda, Senior Editor
FRIDAY, Dec. 16, 2011 — Suzanne Somers has never cared much for convention. Given a choice between business as usual and the road not taken, she’ll almost always choose the latter — especially where her health is concerned. In 2006, she sparked a much-publicized debate when she spoke out in favor of bioidentical hormone therapy, a controversial treatment for menopause that was the subject of her book Ageless: The Naked Truth About Bioidentical Hormones. Then, in 2008, she made headlines again when she published another book, Knockout, advocating alternative cancer treatments over traditional methods like chemotherapy and radiation.
“I appreciate health care that gets to the root cause of our symptoms and promotes wellness, rather than the one-size-fits-all drug-based approach to treating disease,” explains Somers, 65. “I love maintaining an optimal quality of life — naturally.”
Somers first began researching alternative cancer therapies in 2001, after doctors found a tumor in one of her breasts. At the time, she declined chemotherapy but had a lumpectomy and 35 days of radiation, which left the right side of her chest deflated and small. Surgeons offered her two reconstructive options: implants (plural, meaning they would have to also remove her healthy breast) or a TRAM flap, a procedure that uses muscle, fat, and skin from the abdomen to create a new breast. Most women seeking post-treatment reconstruction choose one or the other — but Somers is not most women.
“I said, ‘Sew me back up,’” she recalls. “I knew something better would come along.”
The Birth of Cell-Assisted Lipotransfer for Breast Reconstruction
A few years later, something did come along. In 2003, Kotaro Yoshimura, MD, a professor and surgeon at the University of Tokyo in Japan, began testing an innovative procedure he called cell-assisted lipotransfer, or CAL, in which autologous adipose-derived stem cells (those extracted from a person’s own fat) are injected along with other fat cells to plump up or replace tissue, as in the breast.
Transplanting fat alone is not a particularly novel undertaking — fat transplants were first performed more than a century ago and have been used by cosmetic surgeons in recent years to fill wrinkles, lift buttocks, and enlarge breasts, among other things — but fat transplantation does have a somewhat controversial history. The American Society of Plastic Surgeons deemed it safe only within the last couple of years, and some questions still remain about its long-term risks and viability. Plus, because it takes several days for blood vessels to reach the transplanted fat, some of the cells (as much as 60 percent) die or atrophy after injection, often resulting in the need for follow-up procedures. And while there’s little chance of rejection with fat grafts — because they’re your body’s own tissue — there is a risk of calcification (hardening), which some experts worry could interfere with future breast cancer diagnoses.
To help remedy some of these issues, Dr. Yoshimura came up with the idea to enrich the injected fat with a higher concentration of stem cells. Stem cells are thought to help preserve and even regenerate fat cells by stimulating growth of blood vessels.
Adipose tissue, or body fat, already contains a certain number of stem cells — about one for every four adipocyte fat cells — but Yoshimura and his colleagues believed that increasing the concentration could enhance survival rates of the tissue and reduce post-operative atrophy. To do this, they used liposuction to remove fat from another part of the patient’s body (for example, her stomach, hip, or thigh), set aside a portion of it to be reinjected, and then isolated the stem cells from the remaining tissue to be combined with the reserved fat. This stem cell-rich mixture was then used as a kind of natural cosmetic filler.
Initial results were promising, and other trials soon followed. To date, Yoshimura has performed the procedure on more than 400 women.