THE ROLE OF STEM CELLS IN PLASTIC SURGERY

What are they?

Stem cells (primitive body cells) are distributed throughout body, with the biggest concentration being found in fatty tissue. Harvesting stem cells from body fat – which can be extracted from various parts of the body via liposuction – is a major and promising technological advancement in medicine. Different medical fields use stem cells in various ways. However, evidently, in plastic surgery, the stem-cell enrichment of grafted fat does increase its survival rate.

The stem-cell technique may be applied in the nasolabial folds, the cheeks, the lips and anywhere else fillers are used. This technique, though, has been increasingly applied in breast augmentation as well.

It is a well-known fact that fat grafting in plastic surgery is not a very popular practice, since only 20-30% of the grafted fat survives. Nowadays, however, by enriching the grafted fat with endogenous stem cells, the survival rate has reached 90-95%. This provides the opportunity to use autologous (own) fat to repair various depressions of the body. These depressions may be congenital (since birth), such as hemifacial atrophy, or a result of injuries or surgeries to remove tumors (e.g. a breast tumor). During breast tumor surgery, the mastectomy may be partial (segmental) or complete. Stem-cell enriched fat grafting replaces the missing breast volume and the immediate surgical result is stable over time.

The same technique is also employed in cosmetic surgery, filling the nasolabial folds, the cheeks, the lips and any other parts where fillers (e.g. hyaluronic acid) are used, which have to be repeated every 4-6 months. This technique, though, has been increasingly applied in breast augmentation. Up until now, the fat grafting technique had not been successful in breast augmentation. Firstly, because 70-80% of the fat disappeared in a short while (3-4 months) and secondly, because it left internal scarring, which a mammogram could not distinguish from cancerous tumors. Stem-cell enriched fat has brought revolution to the fat-grafting technique. The stem cells seem to produce new blood vessels in the grafted fat, ensuring its perfusion and, therefore, its survival.

How is the procedure performed?

The procedure begins by selecting the areas where liposuction has to be performed. Through liposuction, and following anesthesia, the fat is harvested and half of it is then processed to produce stem cells. With this technique, the patient also benefits by having an additional cosmetic surgery, that of liposuction.

A machine then processes the fat and in about two hours produces a small quantity of stem-cell enriched liquid. This liquid is then added to the remaining fat that was kept after the liposuction. The fat is then implanted in the areas manifesting depressions (i.e. the face, the lips or the breast, for augmentation or reconstruction) using special syringes.

What type of anesthesia is required?

Depending on the amount of fat that will be extracted and the areas from where it will be extracted, the surgeon may choose between general anesthesia and neuroleptoanalgesia (twilight anesthesia). The patient then wakes up and two hours later, local anesthesia is used to implant the fat.

Ideal candidate and age

The ideal patient is anyone who has volume depressions in any part of their body. The most impressive and interesting case, though, is breast augmentation. Because a great volume of fat is needed to significantly augment the breast, the patient has to have adequate fat in the gluteal region and the abdomen. Therefore, a thin woman who wants breast augmentation is not an ideal candidate for this type of surgery. On the other hand, minor repair on breast volume during reconstruction following mastectomy is possible, since the volume does not have to be that great.

Pre- and Postoperatively

Patients do not need to do anything special pre- or postoperatively, apart from taking antibiotics and wearing an elastic compression garment for a month on the area where the liposuction was performed.

Risks

There are no risks associated with this surgery, apart from any complications that may arise due to infection of the implanted fat. This, however, can be avoided by taking antibiotics.

Results

It is a well-known fact that a large part of the implanted fat is absorbed.