Autologe Fetttransplantation der Brust – Wo stehen wir heute?

Zusammenfassung

Die Transplantation von autologem Fettgewebe in die weibliche Brust löst seit ihrer Erstbeschreibung Kontroversen aus. Anfänglich stand die mögliche Morbidität bzw. Einschränkung der onkologischen Diagnostik durch Kalzifikationen oder Zysten im Vordergrund. Seitdem zunehmend auch ein Einsatz zur Korrektur von Volumendefiziten nach brusterhaltender Therapie oder Rekonstruktion eines Mammakarzinoms erfolgt, rücken Fragen der onkologischen Sicherheit in den Vordergrund. Besonders die zusätzliche Anreicherung von Stammzellen wirft hierbei zahlreiche Fragen auf. Hinzu kommt, dass das technische Vorgehen in praktisch keinem Teilschritt abschließend evaluiert und standardisiert ist.

Dennoch handelt es sich nach den bisher vorliegenden Erfahrungen um eine vielversprechende Technik mit geringer Komplikationsrate und großem Potenzial für die Korrektur kleinerer Volumendefizite oder Strahlenfolgen. Für die Applikation in potenziellem Risikogewebe nach Mammakarzinom sind noch viele Fragen ungeklärt. Die Rolle von angereicherten Stammzellen ist noch weitgehend ungeklärt. Ihr Einsatz ist daher nur in kontrollierten Studien sinnvoll.

Für eine abschließende Bewertung der Eigenfetttransplantation reichen die bisherigen Erfahrungen nicht aus. Der Einsatz sollte daher zurückhaltend, bei selektieren Patientinnen und in einem Umfeld erfolgen, das eine engmaschige, strukturierte Nachsorge ermöglicht.

Abstract

Autologous fat transplantation has shown to be reliable and safe in correcting volume deficits in almost all areas of the body. Recently, there has been an increasing interest in the use of fatty tissue to fill defects resulting from breast conserving surgery and asymmetries after reconstructive breast surgery.

However, injection of fat into a previous tumor site may create a new environment for cancer and adjacent cells. Especially the application of enriched stem cell suspension rise many questions. Also virtually every step of the process remains to be evaluated and standardized. We describe and discuss the technique and highlight possible areas of concern.

Even though many questions remain to be answered the technique has shown a low complication rate so far and seems a versatile tool in plastic surgery to reconstruct volume deficits and post radiation sequela. The benefit and oncologic safety of stem cells enrichment remains to be proved and should therefore only be used in controlled trials.

For a final validation of autologous fat transplantation the current data is not sufficient. Until then, lipofilling should be performed in well selected patients, experienced hands, and a cautious oncologic follow-up protocol is advised.

Schlüsselwörter

Lipofilling - autologe Fetttransplantation - Brust

Key words

adipose tissue - autologous transplantation - fat transfer - breast surgery - lipomodelling

• Literatur

• 1 Alexander RW. Fat Transfer with Platelet-Rich Plasma for Breast Augmentation. In: Shiffman MA. Autologous fat transplantation. New York: Marcel Dekker; 2001: 451-469
• 2 Alexander RW. Liposculpture in the superficial plane: closed syringe system for improvement in fat removal and free fat transfer. Am J Cosmet Surg 1994; 11: 127-134
• 3 Alexander RW. Use of fat grafts for augmentation mammoplasty. Summary of clinical information with radiographic documentation. Newport Beach, CA: Proceedings of the American Society of Cosmetic Breast Surgery; 1998
• 4 Altmann AM, Prantl LM, Mühlberg F et al. Wound microenvironment sequesters Adipose-Derived Stem Cells in a Murine Model of Reconstructive Surgery in the Setting of concurrent distant malignancy. Plast Reconstr Surg 2011; 127 (04) 1467-1477
• 5 Bircoll MJ. New frontiers in suction lipoectomy. Second Asian Congress of Plastic Surgery 1984; 80 (04) 647
• 6 Botteri E, Bagnardi V, Rotmensz N et al. Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol 2010; 21: 723-728
• 7 Büttemeyer R, Hohle R, Meyer-Gattermann W et al. Late Complications following autologous and homologous fat transplantation for breast augmentation. Eur J Plast Surg 1994; 17: 23-27
• 8 Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: Safety and efficacy. Plast Reconstr Surg 2007; 119: 775-785
• 9 Coleman SR. Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg 1995; 19 (05) 421-425
• 10 Delay E, Garson S, Tousson G et al. Fat injection to the breast: technique, results, and indications based on 880 procedures over 10 years. Aesthet Surg J 2009; 29 (05) 360-376
• 11 Dominici M, Le BlancK, Mueller I et al. Minimal criteria for defining multipotent mesenchymal stromal cells: The International Society for Cellular Therapy position statement. Cytotherapy 2006; 8: 315-317
• 12 Eder M, Schneider A, Feussner H et al. Brustvolumenbestimmung anhand der 3D-Oberflächengeometrie: Verifizierung der Methode mit Hilfe der Kernspintomographie. Biomed Tech 2008; 53: 112-121
• 13 Darby S, McGale P, Correa C. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) et al. Effect of radiotherapy after breast-conserving surgery on 10 year recurrence and 15 year breast cancer death: meta- analysis of individual patient data of 10 801 women in 17 randomised trials. Lancet 2011; 378 (9804) 1707-1716
• 14 Frederiksson I. Thesis of the Department of Surgery, Söderjukhuset, Karolinska Institutet Stockholm, Schweden: the Center of Surgical Siences and the Department of Surgical Siences, Uppsala University, Uppsala Schweden: Local recurrence after Breast conserving surgery in Breast Cancer. Stockholm: Karolinska University Press; 2002 ISBN 91-7349-255-8
• 15 Gutowski KA. Current applications and safety of autologous fat grafts: a report of the ASPS fat graft task force. Plast Reconstr Surg 2009; 124: 272-280
• 16 Herold C, Ueberreiter K, Cromme F et al. MRT-Volumetrie der Mamma zur Kontrolle der Fettresorptionsrate nach autologem Lipotransfer. Handchir Mikrochir Plast 2010; 42 (02) 129-134
• 17 Herold C, Ueberreiter K, Cromme F et al. Is There a Need for Intrapectoral Injection in Autologous Fat Transplantation to the Breast? – An MRI Volumetric Study. . Handchir Mikrochir Plast Chir 2011; 43 (02) 119-124
• 18 http://www.clinicaltrials.gov/ct2/show/NCT00616135?term=restore-2&rank=1
• 19 Hörl HW, Feller AM, Biemer E. Technique for liposuction fat reimplantation and long-term volume evaluation by magnetic resonance imaging. Ann Plast Surg 1991; 26: 248-258
• 20 Hyakusoku H, Ogawa R, Ono S et al. Complications after autologous fat injection to the breast. Plast Reconstr Surg 2009; 123 (01) 360-370 discussion 371–372
• 21 Illouz YG, Sterodimas A. Autologous fat transplantation to the breast: a personal technique with 25 years of experience. Aesthetic Plast Surg 2009; 33 (05) 706-715
• 22 Iyengar P, Combs TP, Shah SJ et al. Adipocyte-secreted factors synergistically promote mammary tumorigenesis through induction of anti-apoptotic transcriptional programs and protooncogene stabilization. Oncogene 2003; 22: 6408-6423
• 23 Karnoub AE, Dash AB, Vo AP et al. Mesenchymal stem cells within tumour stroma promote breast cancer metastasis. Nature 2007; 449 (7162) 557-563
• 24 Kauer-Dorner D, Pötter R, Resch A et al. Partial breast irradiation for locally recurrent breast cancer within a second breast conserving treatment: Alternative to mastectomy? Results from a prospective trial. Radiother Oncol 2011; [Epub ahead of print]
• 25 Keck M, Zeyda M, Gollinger K et al. Local anesthetics have a major impact on viability of preadipocytes and their differentiation into adipocyte. Plast Reconstr Surg 2010; 126 (05) 1500-1505
• 26 Kneeshaw PJ, Lowry M, Manton D et al. Differentiation of benign from malignant breast disease associated with screening detected microcalcifications using dynamic contrast enhanced magnetic resonance imaging. Breast 2006; 15: 29-38
• 27 Kovacs L, Yassouridis A, Zimmermann A et al. Optimization of 3-Dimensional Imaging of the Breast Region with 3-Dimensional Laser Scanners. Ann Plast Surg 2006; 56 (03) 229-236
• 28 Kwak JY, Lee SH, Park H et al. Sonographic findings in complications of cosmetic breast augmentation with autologous fat obtained by liposuction. J Clin Ultrasound 2004; 32: 299
• 29 Linford AJ, Meretoja TJ von Smitten KA, Jahkola TA. Skin-sparing mastectomy and immediate breast reconstruction in the management of locally recurrent breast cancer. Ann Surg Onc 2010; 17 (06) 1669-1674
• 30 Lohsiriwat V, Curigliano G, Rietjens M et al. Autologous fat transplantation in patients with breast cancer: “silencing” or “fueling” cancer recurrence?. The Breast 2011; 20: 351-357
• 31 Manabe Y, Toda S, Miyazaki K et al. Mature adipocytes, but not preadipocytes, promote the growth of breast carcinoma cells in collagen gel matrix culture through cancer stromal cell interactions. J Patholol 2003; 201: 221-228
• 32 May H. Transplantation and regeneration of tissue. Pennsylvania Med J 1941; 45: 130
• 33 Minn KW, Min KH, Chang H et al. Effects of fat preparation methods on the viabilities of autologous fat grafts. Aesthetic Plast Surg 2010; 34: 626-631
• 34 Muehlberg FL, Song YH, Krohn A et al. Tissue-resident stem cells promote breast cancer growth and metastasis. Carcinogenesis 2008; 30: 589-597
• 35 Murray C. Tumour dormancy: not so sleepy after all. Nat Med 1995; 1: 117-118
• 36 Nguyen A, Pasyk KA, Bouvier TN et al. Comparative study of survival of autologous adipose tissue taken and transplanted by different techniques. Plast Reconstr Surg 1990; 85: 378-386
• 37 Niechajev I, Sevcuk O. Long-term results off fat transplantation: clinical and histologic studies. Plast Reconstr Surg 1994; 94: 496-506
• 38 Pallua N, Pulsfort AK, Suschek C et al. Content of the growth factors bFGF, IGF-1, VEGF, and PDGF-BB in freshly harvested lipoaspirate after centrifugation and incubation. Plast Reconstr Surg 2009; 123 (03) 826-833
• 39 Panettiere P, Accorsi D, Marchetti L et al. Large-Breast Reconstruction Using Fat Graft Only after Prosthetic Reconstruction Failure. Aesthetic Plast Surg 2011; 35 (05) 703-708
• 40 Pearl RA, Leedham SJ, Pacifico MD. The safety of autologous fat transfer in breast cancer: Lessons from stem cell biology. J Plast Reconstr Aesthet Surg 2011; [Epub ahead of print]
• 41 Peer L. Loss of weight and volume in human fat grafts with postulation of a cell survival theory. Plast Reconstr Surg 1950; 5: 217-230
• 42 Petit JY, Lohsiriwat V, Clough KB et al. The oncologic outcome and immediate surgical complications of lipofilling in breast cancer patients: a multicenter study-milan-paris-lyon experience of 646 lipofilling procedures. Plast Reconstr Surg 2011; 128 (02) 341-346
• 43 Petit JY, Clough K, Sarfati I et al. Lipofilling in breast cancer patients: From surgical technique to oncologic point of view. Plast Reconstr Surg 2010; 126: 262e-263e
• 44 Pierrefeu-Lagrange AC, Delay E, Guerin N et al. Évaluation Radiologique des Seins Reconstruits Ayant Bénéficié d’un Lipomodelage. Ann Chir Plast Esthet 2006; 51: 18e-28e
• 45 Pohl P, Hebel CO. Complications with homologous fat grafts in breast augmentation surgery. Aesthet Plast Surg 1985; 9: 87
• 46 Pulagam SR, Poulton T, Mamounas EP. Long-term clinical and radiologic results with autologous fat transplantation for breast augmentation. Breast J 2006; 6 (01) 63-67
• 47 Pulsfort AK, Wolter TP, Pallua N. The effect of centrifugal forces on viability of adipocytes in centrifuged lipoaspirates. Ann Plast Surg 2011; 66 (03) 292-295
• 48 Rennekampff HO, Reimers K, Gabka CJ et al. Current perspective and limitations of autologous fat transplantation – consensus meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgeons at Hannover; September 2009. Handchir Mikrochir Plast Chir 2010; 42 (02) 137-142
• 49 Rietjens M, De Lorenzi F, Rossetto F et al. Safety of fat grafting in secondary breast reconstruction after cancer. J Plast Reconstr Aesthet Surg 2011; 64: 477-483
• 50 Rohrich RJ, Sorokin ES, Brown SA. Search of improved fat transferviability: a quantitative analysis of the role of centrifugation and harvestsite. Plast Reconstr Surg 2004; 113: 391e-397e
• 51 Rosing JH, Wong G, Wong MS et al. Autologous Fat Grafting for Primary Breast Augmentation: A Systematic Review. Aesthetic Plast Surg 2011; 35 (05) 882-890
• 52 Schaffler A, Scholmerich J, Buechler C. Mechanisms of disease: adipokines and breast cancer – endocrine and paracrine mechanisms that connect adiposity and breast cancer. Nat Clin Pract Endoc 2007; 3 (04) 345e-354e
• 53 Schorcher F. Fettgewebsverpflanzung bei zu kleiner Brust. München Med Wochenschr 1957; 99 (14) 489
• 54 Shiffman MA. History of autologous fat transfer. In: Shiffman MA. Autologous fat transplantation. New York: Marcel Dekker; 2001: 1
• 55 Smith P, Adams WP, Lipschitz AH et al. Autologous human fat grafting: effect of harvesting and preparation techniques on adipocyte graft survival. Plast Reconstr Surg 2006; 117: 1836e-1844e
• 56 Sun B, Roh KH, Park JR et al. Therapeutic potential of mesenchymal stromal cells in a mouse breast cancer metastasis model. Cytotherapy 2009; 11: 289-298
• 57 Ullmann Y, Shoshani O, Fodor A et al. Searching for the favourable donor site for fat injection: in vivo study using the nude mice model. Dermatol Surg 2005; 31: 1304-1307
• 58 Veber M, Tourasse C, Toussoun G et al. Radiographic Findings after Breast Augmentation by Autologous Fat Transfer. Plast Reconstr Surg 2011; 127 (03) 1289-1299
• 59 Vona-Davis L, Rose DP. Angiogenesis, adipokines and breast cancer. Cytokine Growth Factor Rev 2001; 20 (03) 193e201-193e201
• 60 Walter M, Liang S, Ghosh S et al. Interleukin 6 secreted from adipose stromal cells promotes migration and invasion of breast cancer cells. Oncogene 2009; 28 (30) 2745e-2755e
• 61 Yoshimura K, Sato K, Matsumoto D. Cell-Assisted Lipotransfer for Breast Augmentation: Grafting of Progenitor-Enriched Fat Tissue. Autologous Fat Transfer 2010; Part 3: 261-271
• 62 Yu JM, Jun ES, Bae YC et al. Mesenchymal stem cells derived from human adipose tissues favor tumor cell growth in vivo. Stem Cells Dev 2008; 17: 463-473
• 63 Zhu M, Zhou Z, Chen Y et al. Supplementation of fat grafts with adipose-derived regenerative cells improves long-term graft retention. Ann Plast Surg 2010; 64 (02) 222-228
• 64 Zimmerlin L, Donnenberg AD, Rubin JP et al. Regenerative Therapy and Cancer: in vitro and in vivo studies of the interaction between adipose-derived stem-cells and breast cancer cells from clinical isolates. Tissue Eng Part A 2011; 17 (01–02) 93-106
• 65 Zocchi ML, Zuliani F. Bicompartmental breast lipostructuring. Aesthetic Plast Surg 2008; 32 (02) 313-332