Understanding cell therapy & fat grafting
Plastic reconstructive surgery using “cell therapy” to “reconstruct” instead of tissue transfer, will bean importantof part of the reconstructive ladder for the plastic surgeon in the future. Our adult tissues and organs have an innate capacity to regenerate. A good example is our liver which has a tremendous capacity to regenerate. We can now “reconstruct” tissues or repair organs previously impossible. Our reconstruction skills in the near future can be applied to tissues and organs for example in regenerating cardiac muscle in heart failure, renal tissues, lung tissues, cartilage, retina and nerve tissues that previously impossible.
The term “stem cell” is grossly misrepresented and understood by many individuals, clinicians and scientists related to this industry resulting in a poor understanding and unwarranted concernsonthe risks. This has resulted in the delay in embracing autologous cell therapy in all aspects of medicine.
I hope to clear this for those who are confused- patients, clinicians and scientists.
First of all, cell therapy is not stem cell therapy. In our body, there are special cells that have the capacity to “heal” by stimulating blood flow and assistingdamagecells to regenerate by releasing cytokines (cellular hormones or signals). These cytokines initiate a series of cascade reaction resulting in healing or regenerative process.
What are these special cells and where do they comefrom ?
Depending on the source, they have different names and morphology (cell type or shape) BUT they all have a common function or end point, that is to stimulate a series ofhealingprocess and blood flow.
In cell therapy, we capture and concentrate these special cells and are commonly referred to as “regenerative cells”.
In fat, (adipose tissues), these cells are commonly called adipose derived cells (ADRC) or stromal vascular rich cells (SVRC). In the liver, the cells are often called hepatocytes epithelial cells or sinusoidal endothelial cells. In the blood stream, it is the platelets and hence the “platelets rich plasma” PRP therapy as it is now commonly known insportmedicine.
Regardless of the origin, the end goal is to produce a cascade of cytokines to initiate the healing, repair or regeneration process. In cell therapy, we capture and concentrate these cells to the area we wish to “heal” or regenerate.
About 20 years ago, a series of these cytokines was found to “heal or regenerate” damage tissues and fascinated clinicians and scientist alike. It was hailed as the magic bullet in transforming diseased or damaged organs back to healthy tissues. The scientists at that time called these engimatic cytokines “Transforming growth factors”. My paper on “What is transforming growth factor ?” published in the British Journal of Plastic Surgery in 2004 speculated to the future on where we are today.
The cytokines described above are essentially ‘transforming growth factors’. This is the backbone of cell therapy or regenerative surgery. Regenerative surgery is currently the most rapidly growingspecialtyin medicine and offers a natural solution to many injuries or diseases that were previously deemed impossible to treat.
Cell therapy with fat grafting for breast reconstruction or augmentation do not increase the risk of breast cancer or recurrence. A controlled study by Kronowitz (2016), published in the Journal of Plastic & Reconstructive Surgery, February 2016 has shown that using fat grafting for breast reconstruction do not have an increased riskin breast cancer or recurrence.
What is regenerative cells plastic surgery?
Conventionally, plastic surgeons ‘reconstruct’ by utilising adjacent or distant parts of the body using flaps or micro-surgery.Howeverwith regenertaive cells plastic surgery, the required tissue needed for reconstruction can be obtained by using the patient’s cells to ‘regenerate’ into the type of tissue that is required.
This regeneration of tissue is achieved by using autologous (self) ‘regenerative cells’, that has the potential to differentiate into a variety of cells such as muscle, blood vessels, fat and nerves. It gives us plastic surgeons another dimension or option for reconstruction.
In the past, regenerative cells were thought to exist only in the embryonic or fetus stage of human development but we now know that stem cells exist in adults. One of the richest sources of regenerative cells is from fat cells (Zuk & Hedrick 2002). Human fat cells have the potential to differentiate into other different types of cells in the body. As such, human body fat can be used to regenerate body tissue and facilitate reconstruction of various body parts.
Adipose derivedregenerative cells therapy is currently used for natural breast augmentation and replacement of silicone implants and for facial rejuvenation.
There is far more regenerative cells in fat than bone marrow (Zuk & Hedrick 2002)
I now routinely performed breast reconstruction using cell therapy in breast cancer patients who had radiotherapy as a day case. We currentlyhasthe largest and longest cell therapy breast reconstruction database in Australia.
Advanced plastic surgery procedures
- Natural breast augmentation
- Replacement of silicone breast implants augmentation
- Breast reconstruction post mastectomy
- Facial facelift rejuvenation
- Parry-Romberg’s Syndrome
1. What makes this procedure unique?
· Patients’ own fat tissue is enriched with ADRCs, which are a mixed population of regenerative cells, including stem cells, that reside naturally in fat tissue
2. How are the cells obtained?
· Cells are taken out of the patient’s own fat tissue in the OR with the standard conventional liposuction. I have used a variety of different system through the same but essentially, the standard physiology in handing free tissue grafts applies. Liposuction under low-pressure liposuction seems to be the most reliable constant in the outcome of volume retention.
3. Is the procedure safe?
· Early clinician experience and clinical data has demonstrated that cell-enriched breast reconstruction is safe.
· Patients who have undergone cell-enriched breast reconstruction treatment should undergo routine follow-up
· It’s important for physicians to follow best clinical practice, particularly in the area of patient assessment and selection
4. Do the addition of regenerative cells to the fat graft cause cancer or increase the risk or recurrence?
· Based on today’s knowledge, there is no reason to believe that ADRCs cause breast cancer to develop or recur.
· More than 2,000 patients have undergone this type of procedure with no increased incidence has been observed.
· The cells used to enrich the graft are occur naturally in breast tissue.