Application of adipose-derived stromal cells in fat grafting: Basic science and literature review

Autologous fat is considered the ideal material for soft‑tissue augmentation in plastic and reconstructive surgery. The primary drawback of autologous fat grafting is the high resorption rate. The isolation of mesenchymal stem cells from adipose tissue inevitably led to research focusing on the study of combined transplantation of autologous fat and adipose derived stem cells (ADSCs) and introduced the theory of ʻcell‑assisted lipotransferʼ. Transplantation of ADSCs is a promising strategy, due to the high proliferative capacity of stem cells, their potential to induce paracrine signalling and ability to differentiate into adipocytes and vascular cells. The current study examined the literature for clinical and experimental studies on cell‑assisted lipotransfer to assess the efficacy of this novel technique when compared with traditional fat grafting. A total of 30 studies were included in the present review. The current study demonstrates that cell‑assisted lipotransfer has improved efficacy compared with conventional fat grafting. Despite relatively positive outcomes, further investigation is required to establish a consensus in cell‑assisted lipotransfer

Free tissue transfer after unsatisfactorily implant-based breast reconstruction, a cohort study

Breast reconstruction can be performed using implants or autologous tissue, either alone or in combination. Implants typically require re-operation during the patient's lifetime, often for adverse capsular contracture. Conversion from implants to autologous tissue may improve symptoms and deliver a definitive reconstruction. This is known as salvage breast reconstruction. In this paper we evaluate the indications, outcomes, complications and cost implications of salvage breast reconstruction in our regional centre and report these in line with the STROBE guidelines. Retrospective casenote analysis of all salvage breast reconstruction patients from January 2018 to January 2020 was performed. Nineteen patients were identified, with a median age of 52 years. Indications were all capsular contracture other than two each of implant rupture and patient request. Thirty-two perforator free flaps; 29 deep inferior epigastric, two profunda artery and one lateral thoracic artery flap were performed. Median time from first implant to free flap reconstruction was nine years. Median hospital stay was five days. No total flap losses and one partial flap loss occurred. Three patients underwent secondary procedures to the breast to improve the aesthetic outcome. All patients reported improvement in symptoms and appearance. For implant-intolerant patients adequately counselled and accepting of the post-operative downtime, salvage reconstruction with autogenous tissue offers a lasting solution. The upfront healthcare costs are higher with a free tissue transfer, but may become comparable longer term given the multiple exchange of implant procedures required over a patient's lifetime

Application of adipose-derived stromal cells in fat grafting: Basic science and literature review (Review)

Autologous fat is considered the ideal material for soft-tissue augmentation in plastic and reconstructive surgery. The primary drawback of autologous fat grafting is the high resorption rate. The isolation of mesenchymal stem cells from adipose tissue inevitably led to research focusing on the study of combined transplantation of autologous fat and adipose derived stem cells (ADSCs) and introduced the theory of `cell-assisted lipotransfer'. Transplantation of ADSCs is a promising strategy, due to the high proliferative capacity of stem cells, their potential to induce paracrine signalling and ability to differentiate into adipocytes and vascular cells. The current study examined the literature for clinical and experimental studies on cell-assisted lipotransfer to assess the efficacy of this novel technique when compared with traditional fat grafting. A total of 30 studies were included in the present review. The current study demonstrates that cell-assisted lipotransfer has improved efficacy compared with conventional fat grafting. Despite relatively positive outcomes, further investigation is required to establish a consensus in cell-assisted lipotransfer