Breast Augmentation Using Fat and Stem Cells

History of the technique
Japanese surgeon Kotaro Yoshimura has recently resurrected an old idea: grafting fat for breast augmentation.

The idea of cosmetic fat transplant dates back more than a century, but failures caused the idea to fall out of favor with surgeons. In previous procedures, most of the grafted fat died, forming hard lumps or calcifications.

Dr. Yoshimura has taken this old idea and given it a modern twist: stem cells. Not the embryonic stem cells that are the subject of much controversy and ethical issues, but stem cells from within the patient's own fat. Over a decade ago it was discovered that fat contains stem cells, similar to those in bone marrow.

He calls his procedure "cell-assisted lipotransfer," and has performed about 200 of these operations since he began testing his technique in 2003.

How it works
First, fat is siphoned from the patient's leg or abdomen. Half of this fat is processed in a centrifuge, and the resulting stem-cell concentrate is mixed back into the other half. The mixture is then injected back into the patient using four injection sites per breast. The entire process takes 3 to 4 hours.

How much of a graft will survive cannot be predicted, but Dr. Yoshimura says his average graft survival rate is 54%. This makes it difficult to make large changes, however the operation can be repeated if larger breasts are desired. It can take up to three months for the true results to be clear, as the tissue volume needs time to stabilize.

Advantages and concerns
Many are excited about this new technique, as it is said to produce soft, natural looking breasts with none of the risks associated with ruptured saline or silicone implants. However, there are a number of concerns:

• There is no long-term data on the consequences of the procedure.


• Since the U.S. FDA only regulates medical devices and not medical procedures, safety is a concern, though the FDA has said that the "biologic product" of fat augmented with stem cells would require approval.


• The injected fat (and any resulting calcifications) could interfere with mammography.


• Some doctors worry that adding fat to the breast in this way could increase the risk of breast cancer.

More information needed
More research and clinical trials are needed to evaluate this procedure before it can be made available to the general public.

Dr. Scott Spear is conducting a research project funded by the Aesthetic Surgery Education and Research Foundation (ASERF) to determine the safety and efficacy of the lipoaugmentation procedure. He said, "It is clear that autologous fat transfer around the breast or to create a breast is effective. However, what still needs to be determined are the more intricate details - technique and placement of the fat tissue, who should receive this transfer, when it is appropriate, and whether it is safe to be done at all."

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