The Synergy Between Lipofilling and Adipose Tissue Engineering in Breast Reconstruction

THE SYNERGY BETWEEN LIPOFILLING AND ADIPOSE TISSUE ENGINEERING IN BREAST RECONSTRCUTION

Filip Stillaert, MD

University Hospital Gent, Department of Plastic and Reconstructive Surgery, Belgium

Introduction

Ideally, breast reconstruction involves the use of autologous tissue to restore the morphology of the breast. Microsurgical tissue transfer is a standard procedure to achieve this outcome. Adipose tissue engineering has been touted as an alternative solution to fabricate off-the-shelf adipose tissue constructs for breast reconstruction but so far researchers have only been successful in engineering small-volume adipose tissue constructs. However, the research resulted in a better recognition of the developmental processes in adipogenesis. Fat grafting in breast reconstructive surgery could profit from tissue engineering knowledge using the body's own biological processes as a vector to support the long-term homeostasis of grafted adipose tissue.

Materials & Methods

In a selected group of patients, the less invasive lipofilling technique offers new strategies in autologous breast reconstruction. When fat grafting is chosen as an option in breast reconstruction the major concern is to create the ideal recipient site for fat grafts to survive. Initially, the skin enveloppe is preserved or reconstructed through the insertion of an expander. The device will induce the formation of a periprosthetic capsule, which shapes a distinct and confined subcutaneous space. The expander is left in situ for three months allowing the capsule to consolidate by which time it has developed a rich vascular network, which will nourish the grafted lipoaspirate. At this point, the expander is partially deflated creating a potential space between the capsule and the overlying subcutaneous tissue. This is the space targeted for fat injection. Lipofilling procedures are repeated at three months interval with serial deflation of the expander. Preceding fat injection, the recipient site is infiltrated with autologous plasma to support the phenomenon of plasmatic imbibition enhancing fat graft survival. In vitro studies confirmed the supportive role of plasma in the survival of fat grafts.

Results

All patients (n=7) underwent a successful complete autologous breast reconstruction using the principles derived from tissue engineering research. In all of the patients we were able to achieve symmetrical volumes between both breasts and MRI follow-up showed no signs of tissue necrosis.  Mean follow-up was one year. Intraoperative endoscopic views of the capsule and the injected fat confirmed the rich vascular network, the presence of the fat grafts and the striking similarities with the tissue engineering chamber.

Conclusion

The use of internal expansion and lipofilling is an attractive strategy to reconstruct a breast in a selected group of patients. Expansion generates a highly vascularised and well-defined recipient site to harbour the fat graft which leads to the generation of a homeostatic tissue construct mimicking the environment of the tissue engineering chamber. Cryopreservation could introduce  the possibility to perform ambulatory breast reconstruction avoiding the morbidity of several anesthesias and repetitive liposuction procedures.