Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance, and size following mastectomy. Today, plastic surgeons may use flap techniques to reposition a woman’s own muscle, fat, and skin to create or cover the breast mound. Or, they may provide breast reconstruction with tissue expansion which allows an easier recovery than flap procedures. Tissue expansion stretches healthy skin to provide coverage for a breast implant, however it requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin. A breast implant—saline or silicone—can also be an addition or alternative to flap techniques.
In Japan, Europe, and Israel surgeons are harvesting fat and stem cells from hips and thighs to sculpt breasts without the leaks, slippage, and short shelf life that often accompany saline and silicone implants. The procedure is controversial among researchers in the United States (it's not available here...yet—human studies could begin in the next 3 to 5 years). "These are adult stem cells, not embryonic cells, so the concern isn't an ethical one about an embryonic source," says McGowan Institute
faculty member J. Peter Rubin, MD, co-founder and chairman of the International Federation of Adipose Therapeutics and Science. "Stem cells from fat tissue can turn into blood vessels and make new fat cells, so they could create long-lasting tissue for breast augmentation and reconstruction. But there are safety issues."
One safety issue is cancer. "We don't know yet whether these cells have the potential to go awry and become tumor cells themselves or whether they could influence cancer cells left behind in breast cancer patients undergoing reconstruction," Dr. Rubin says. "We also don't know whether injecting fat into the breast could obscure small cancers normally detected by mammograms."
To find answers to this and other safety issues, research studies are being performed at the Adipose Stem Cell Center, Division of Plastic Surgery, University of Pittsburgh School of Medicine. There, scientists led by co-directors Dr. Rubin and Kacey Marra, PhD, are isolating, characterizing, and testing adult stem cells from fat. Fat, or adipose tissue, contains an abundant number of adult stem cells, over 10 times more than in bone marrow. These cells not only regenerate adipose tissue, but they can reconstruct a variety of injuries and defects by being coaxed to develop into nerves, bone, or cartilage.
The Center partners physician-researchers with investigators in the fields of tissue engineering, cell therapy, adipose biology, stem cell physiology, and growth and development. Together they are conducting scientific studies on a post-cancer breast reconstruction technique that uses a woman’s own stem cells, isolated from a sample of her fat, to form a breast with the look and feel of natural tissue. The expertise and efforts of the Center’s team of medical and scientific professionals continue to move forward to translate their findings into new medical treatments.
Illustration: Adipose tissue cells. –Pittsburgh Tissue Engineering Initiative.
Oprah Magazine (02/2009)
Adipose Stem Cell Center
American Society of Plastic Surgeons: Breast Reconstruction
Bio: Dr. Kacey Marra
Bio: Dr. J. Peter Rubin