Autologe Fetttransplantation in der Brustchirurgie – Klinische und Experimentelle Konzepte: vom Lipofilling bis zum Fettgewebe Tissue Engineering

Zusammenfassung

Die Fettabsaugung ist ein weit verbreiteter Eingriff in der ästhetischen Chirurgie zur lokalen Fettreduktion. In den letzten Jahrzehnten findet das anfallende Gewebe zunehmend Anwendung als biokompatibler Gewebefüller insbesondere auf dem Gebiet der ästhetischen Gesichtschirurgie und in der Narbenkorrektur. Darüber hinaus kann die autologe Fetttransplantation, auch bekannt als Lipofilling, oder Lipotransfer eine Alternative zur Implantat-Brustrekonstruktion oder -Brustaugmentation bieten. Bisher ist allerdings die postoperative Resorption des Fetttransplantates limitierend, sodass häufig mehrere Eingriffe benötigt werden, um das erwünschte klinische Ergebnis zu erreichen. Der therapeutische Effekt der Eigenfetttransplantation beschränkt sich nicht nur auf den Gewebeaufbau als Füllersubstanz, sondern Eigenfett werden gleichwohl durchblutungsfördernde und wundheilende Eigenschaften zugeschrieben. Letzteres ist nicht den ausdifferenzierten Adipozyten, sondern den undifferenzierten stromalen Zellen (adipose derived stromal cells, ASC) zuzuordnen. Diese Erkenntnis führte zu der Weiterentwicklung der autologen Fetttransplantation durch Anreicherung des Eigenfettes mit autologen ASC, bekannt als zellassistierte Fettgewebetransplantation oder zellassistierter Lipotransfer (Cell assisted Lipotransfer, CAL). Vor einer allgemeinen Eta­blierung dieses Verfahrens sind jedoch systematische Analysen zur Beantwortung offener Fragen notwendig. Diese betreffen sowohl die operative Technik als auch qualitative Aspekte, die die Herstellung der supportiven Zellfraktion auf Basis der gesetzlichen Rahmenbedingungen für die Zelltherapie in Deutschland umfassen. Nicht zuletzt müssen Fragen der Stammzellbiologie im Rahmen des zellulären Differenzierungspotenziales in vivo geklärt werden.

Abstract

Liposuction is a most common surgical procedure in aesthetic surgery that aims at the local fat reduction. The obtained adipose tissue is currently used as a biocompatible filler. Autologous fat transplantation, also known as lipofilling, has become an attractive treatment method in the field of aesthetic facial surgery and scar tissue reconstruction. Lipofilling may also offer an alternative method to prosthetic breast surgery. Nevertheless, postoperative fat tissue resorption is still a limitiation to lipofilling in breast reconstruction leading to multiple revisions in order to reach the requested clinical outcome. The therapeutic effect of autologous fat grafts does not solely lie in its role as a filler material, but also in its wound healing and angiogenetic properties. The latter is not attributed to the mature adipocytes, but rather to the undifferentiated adipose derived stromal cells (ASC). Thus enrichment of the fat graft with autologous ASC, known as cell-assisted lipotransfer (CAL) may lead to further optimisation of lipofilling concerning fat graft survival. Still aiming to establish the application of autologous fat grafts and ASC in breast reconstruction, there is a necessity for systematic analyses in order to resolve questions regarding the operational technique and qualitative aspects of the ASC manufacturing in accordance with pharmaceutical guidelines and regulations in Germany. Besides, some open questions need to be addressed regarding the ASC differentiation potential in vivo.

Schlüsselwörter

autologe Fetttransplantation - Lipofilling - stromale Fettvorläuferzellen (ASC) - mesenchymale stromale Zellen (MSC) - zellassistierte autologe Fetttransplantation (CAL) - Gewebegesetz, ATMP

Key words

autologous fat grafting - lipofilling - adipose tissue stromal cells (ASC) - mesencymal stromal cells (MSC) - cell-assisted lipotransfer (CAL) - Tissue and Cell Directive, ATMP

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