Dr. Joel Aronowitz — Stem Cell Enhanced Fat Grafting of the Breast: A Side by Side Trial
Cloe Hakakian BS, Dr. Joel A. Aronowitz MD
Cedars-Sinai Medical Center, University Stem Cell Center, Los Angeles CA
Background: Fat grafting is widely performed but still characterized by inconsistent long term volume retention. A body of research supports the role of adipose stem cells in engraftment and adipose tissue regeneration. Yoshimura suggests stem cell enrichment as a strategy to improve permanent engraftment1. Safety of point of care (POC) cellular enrichment of lipoaspirate is established but conclusive evidence of improved long term volume retention is elusive.
This is a prospective study of women undergoing elective breast augmentation with fat grafting. Each subject underwent fat grafting with unmodified lipoaspirate to one breast and cellular enriched fat grafting on the opposite breast.
Methods: Volunteers were recruited to participate in this blinded trial. Subjects underwent liposuction harvest and approximately 3.8 x 106 viable ADSCs were obtained from 200cc lipoaspirate with a manual collagenase enzyme process at the POC2. One breast received cell enriched fat while the control breast received unmodified fat. Subjects were followed for 6–9 months. Breast volume was evaluated qualitatively by blinded observer and self evaluation for each subject.
Results: Breast volume increased symmetrically in both breasts at 1 month postoperative. At 3 months the enriched breast showed a 35% increase in retained volume compared to the control. After 8 months the breast injected with ADSC increased more than the control breast by a ratio of 1:1.7 representing a 66% increase in long term grafted volume. A blinded observer evaluation and patient self-evaluation correctly assessed the control versus enriched breast 96 and 88% respectively. No complications reported.
Conclusions: Breasts augmented with adipose stem cell enriched fat in this study showed consistently greater volume than the control breast of the same individual. This confirms the efficacy of the CAL strategy and is consistent with data demonstrating the adipogenic, angiogenic, and ultimately tissue regeneration effects of ADSC cells co-implanted with fat graft.
The authors support a more widespread adoption of the technique as part of carefully designed human trials to further improve the efficacy and predictability of fat grafting for a variety of indications.
References:
1. Yoshimura K, Sato K, Aoi N, Kurita M, Hirohi T, Harii K. CAL for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg. 2008;32(1):48–55.
2. Aronowitz JA, Ellenhorn JD. Adipose stromal vascular fraction isolation: a head-to-head comparison of four commercial cell separation systems. Plast Reconstr Surg. 2013;132(6):932e-9e.
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