Stem cells are a hot topic in medicine. Recently concluded clinical trials show that adult stem cells derived from a person’s own fat tissue can safely and effectively be used to reconstruct breasts in women after breast-removal surgery.
This method can also be used to change breasts that have become distorted after a lumpectomy or from scarring and tightness of skin following radiotherapy. It also opens up possibilities for breast, buttock and facial enhancements in women, using their own stem cells.
Australian women have a 1 in 9 lifetime risk of contracting breast cancer. In 2011, around 14,300 Australian men and women were diagnosed with breast cancer, the most common cancer for Australian women. According to Breast Cancer Network Australia, most women survive breast cancer, with the five-year survival rate at over 88 percent.
Mastectomy is a common treatment option for breast cancer, with more than 5,000 Australian women undergoing a full or partial mastectomy each year. Although these women must confront the loss or distortion of one or both breasts, relatively few elect to have breast reconstruction surgery. In the US, only around 25 percent of all mastectomy patients have breast reconstructions; in Australia the percentage is even smaller. More than 80 percent of women bear the social, emotional and physical costs of breast removal and distortion in silence.
In this context, the possibility of breast reconstruction using stem cell technology is great news. It gives hope to women who, for whatever reason, have been reluctant to elect for either a breast reconstruction or implants.
Results of recent clinical trials
The recently published results of a 71-patient clinical trial using stem cells from patients’ own fat tissue (autologous adipose-derived regenerative cell, or ADRC) for breast reconstruction after cancer surgery were positive and encouraging.
The key findings of the trial, published in the European Journal of Surgical Oncology, showed that most researchers and patients were satisfied with the overall treatment results, as well as with the functional and cosmetic results after 12 months. Improvements in breast contours were observed at both six and 12 months after the procedure. Most importantly, there were no instances of cancer recurrence or other serious adverse effects relating to the procedure. The potential danger of the versatile stem cells triggering more cancers in cancer patients has so far prevented the US FDA from approving the procedure. However, the stem cell treatments and the equipment that facilitate the process are already being sold in some parts of Asia and in Europe.
ADRC reconstructions are not banned in the US, because reinjecting one’s own fat and cells is not considered controversial. But without specific clearance, which may or may not be granted depending on the results of clinical trials, providers cannot advertise their services or supporting products to surgeons. The issue of clearance limits the widespread use of the technique.  
According to the Consultant Plastic and Reconstructive Surgeon Mrs. Eva Weiler-Mithoff, a co-principal investigator for the clinical trial at the NHS Glasgow Royal Infirmary Hospital, “This new technique is exciting because it may offer the opportunity to resolve some of the most difficult-to-treat conditions where other approaches, including fat alone, do not achieve satisfactory results.”
How it works
Breast reconstruction with stem cells falls under the umbrella of regenerative surgery, one of the fastest-growing specialty areas in medicine. The stem cells for this purpose are derived from a person’s own fat tissue, doing away with many potential complications. Tissue regeneration using fat and stem cells is minimally invasive and offers a positive alternative to the surgical procedures available for breast reconstruction.
Our body fat is a rich source of stem cells, with each 1cc drop of fat yielding about a million cells. Just like other adult stem cells, those harvested from fat tissue possess the potential to differentiate into a variety of cells, including muscle, blood vessels, nerves and fat.
The first step in the treatment is harvesting body fat. The surgeon sucks out the fat—in a process called liposuction—from the tummy, buttocks, thighs or other locations rich in fatty tissue. Cytori, a pioneering American firm in this field, has developed a device that separates stem cells from the fat and prepares them for reinjection for tissue regeneration. David Oxley of Cytori is “thrilled that we finally have the potential to improve patients’ lives using their own regenerative cells”. The fat, squirted into a machine called a Celution device, is processed using a mix of enzymes that digest the fat tissue, freeing the stem cells. The stem cells are then combined with some of the remaining fat cells, making a mixture containing millions of the stem and regenerative cells. The process takes about two hours.
This mixture is used to provide volume and fill up the divot made in a lumpectomy, the empty skin pouch in a mastectomy or the missing quadrant in a quadrantectomy.
There’s more than one way to regenerate breast tissue. The method employed by doctors working with Cytori is to inject the fat and stem cell solution, droplet by droplet, into the treatment area after making tiny cuts that penetrate the scar tissue and turn it into a biological mesh. This procedure can take as long as four hours per breast to complete. It is more akin to sculpture than surgery. There may be some swelling afterwards, but patients usually experience more discomfort at the liposuction sites than on their treated breasts. Women whose breasts have been damaged by breast cancer treatment, by a lumpectomy and radiation therapy, are good candidates for this method.
This method works well for women who want a natural, soft-tissue feeling in their breasts. On average, an increase of a cup size or two, adding another 100 to 200cc of volume to the breast, is to be expected. Treatment can be repeated each three to four months, as long as there are sufficient levels of donor fat in other areas of the body.
Own-fat injection with stem cells is suitable for people who would never consider a breast implant. Cytori and its researchers believe that many women would be thrilled to have their breasts plumped with cells from their own bodies, reducing the fat in their hips and abdomens at the same time.
Another method, called Neopec, is still at the clinical-trial stage. It involves the use of a biodegradable breast-shaped chamber implanted into the chest. Surgeons redirect under-arm blood vessels into the chamber together with fat cells. A gel is inserted into the chamber to promote cell growth. After four to six months, during which cells multiply and create new breast tissue, the chamber dissolves.
Stem cells mixed with fat tissue are better than simple fat injections, because the regenerative cells promote growth of blood vessels, fat and muscle tissue. It is the ability of the stem cells to develop a blood supply that underlies the success of the procedure. Any tissue given a blood supply will survive without being reabsorbed into the body. This is why fat injections combined with stem cells show better rates of volume retention than fat injections alone. For more information read our article on Autologous Fat Transfer for Breast Enhancement.
Cosmetic potential of stem cell treatments
The regenerative ability of stem cells combined with a person’s own fat tissue broadens the alternatives available to cancer patients who have undergone full or partial mastectomy. The success of this tissue regeneration technique, in addition to its medical potential, opens many possibilities for the profession. The same technique that is used in treating mastectomy patients can be used for women who want breast, buttock and facial enhancements for cosmetic purposes. It can also be used on women who are undergoing surgery to remove breast implants. At least one surgeon associated with Cytori is already providing such cosmetic enhancements.
The true potential of the treatment will only be realised after completion of clinical trials, long-term studies on the safety of the technique, and clearance from the Therapeutic Goods Administration (TGA).
Stem cell reconstruction offers realistic hope for breast cancer patients. It also opens up possibilities for breast, buttock and facial enhancements in women using their own stem cells. Some surgeons are also lobbying to have this treatment registered with Medicare Australia.
Because of their versatility, and because adult stem cells don’t carry the emotional baggage that comes with embryonic stem cells, you can expect to hear more good news on this front in the years to come.