Autologous fat transfer or fat grafting is an option for both breast augmentation and breast reconstruction to restore / enhance volume. It has been found that the key to fat graft retention is maximizing the surface area to volume ratio, and the vascularity of the recipient area. Closed systems and the method of harvest are also seen as essential steps. Reported graft retention following autologous fat transfer may vary from 40 to 75%.
Mr Ross uses water assisted liposuction (Bodyjet liposuction) to aid the removal of fat and limit damage to fat cells during harvesting. The fat is then filtered within a closed system, therefore limiting the chance of pollution / infection prior to injection.
Proponents of cell assisted lipotransfer (CAL) have postulated that adding adipose derived stem cells to autologous fat transfer enhances angiogenesis / adipogenesis leading to improved long-term graft retention and lower post-operative complications,
A recently conducted systematic review of CAL in breast augmentation and reconstruction from the UK has been published on JPRAS open. The authors describe an overall complication rate of 37% with the most common side effect being calcification. They concluded that although a promising surgical technique there were high levels of bias, lack of control groups and lack of long-term follow-up data. They concluded that the potential concerns of CAL vs traditional autologous fat transfer have yet to be determined and all patients wishing to undergo CAL must be aware of the lack of evidence to support its use over traditional autologous fat transfer.
Currently with a lack of evidence to support its use Mr Ross does not routinely advocate the use of CAL at the time of autologous fat transfer.
With technical refinements and the possibility of CAL alongside water assisted liposuction, Mr Ross’s sees CAL as an exciting prospect for his patients in 2017. All patients considered as appropriate will need to be aware of the pros and cons and be happy to be part of a long term follow up clinical study and be empowered to make the decision to proceed on this basis.
Zeeshaan Arshad, Lindsey Karmen, Rajan Choudhary, James A. Smith, Olivier A. Branford, David A. Brindley, David Pettitt, Benjamin M. Davies
Cell assisted lipotransfer in breast augmentation and reconstruction: A systematic review of safety, efficacy, use of patient reported outcomes and study quality. JPRAS Open 10 (2016) 5e20