Monday, February 12, 2007

Stem cell technology potential for breast augmentation or reconstruction

I'm a big Drudge Report fan and I check it once or twice a day to survey the wonderful mix of important or interesting things on the newswire. One of the stories featured today was this from the UK Daily Mail about how fat stem cells have potential to graft or grow new breast and could be used for implants to replace current saline or silicone versions.

This is really an idea not ready for prime-time in the near future. We don't have the technology to grow or implant these cells predictably. Still to be answered are what (if any) effect on the development of breast cancer these cells could have or whether their presence would affect screening mammograms. Fat grafting of the breast, a once seriously taboo topic in Plastic Surgery, has been readdressed in a number of journal articles as a way to fill in some contour irregularities in breast reconstruction.

The problem with fat is that the take of it as a graft material is historically cited as only ~50%, so getting predictable results when large volumes are required cannot be achieved. This has limited interest for it as an augmentation material. The amount of size added from these stem cell was very modest and could not achieve a useful size for most cosmetic cases where we would currently use an implant.

Despite the sexy headline, don't expect anything like this to be widely used in the near future. If you looking for the next big advance for breast surgery in the United States, look forward to the approval of the real high-cohesive form stable implants like the Inamed 410 & Mentor CPG devices.


lalagigi said...

how come you can do fat grafting to the butt with fat taken from elsewhere but not in the breasts..mammograms?

Sonia said...

Good question! (above), I would also love to know the answer to that.

Dr. Oliver, it seems that you are a very impassioned advocate of silicone breast implants and their availability. So we know now that most of the negative publicity about silicone was exagerated and/or unfounded. But isn't it a fact that breast implants in general have a high complication rate? 4 out of 5 of the women that I know who've had augmentation, have had complications.

It would be interesting to see a post on here about the common complications of implants.

Dr. Rob Oliver said...

Lalagigi - the cancer issue has what has traditionally made fat grafting in the breast taboo with breast reconstruction. When fat dies it either hardens or liquifies (or both). It's always worried us that scarred fat grafts would be indistinguishable from breast cancer on mammograms and lead to unneccessary biopsies or delayed diagnosis.

For cosmetic purposes it's usually too hard to get enough size or predictable take of the graft. However, a number of people are now writing about this & there were several lectures on it at one of the big (no pun intended) breast meetings recently in Atlanta.

Sonia my interest in breast devices has more to do with the issue being one of the dramatic changes in practice rather then "passion" about them. I'm also a political junkie and the particular US experience where politics so heavily distorted a medical/science issue for two decades fascinates me.

As to complications rates, that is something else I've in fact touched on a number of times. Clearly the single biggest factor relating to complications of modern devices (saline or silicone) are related to size/weight of the implant and the long-term effect of that on breast tissue. This issue often collides with a patients demands or expectations for how "big" they'll be after surgery. There are several very compelling series published showing single-digit reoperation rates years after implantation using strategies which emphasize long-term implant coverage and certain technical manuevers.

Implants in reconstruction are a completely different animal and most of the complications there are related to the intrinsic wound properties after mastectomy, chemotherapy, and (increasingly) radiation. It will be harder to make the same progress with reducing complications in that population, especially as more & more XRT is used.

I will definately start some posts on these issues as I think they'll be kind of interesting reading.