I love Wired magazine. It gives me a window onto the high-tech electronics world, that being in a biologically based profession I might otherwise be disconnected with. So it’s rather exciting when they feature a story about something that I actually do know something about. And when it’s a cover story, well, that’s even better! So I was definitely interested in reading their most recent cover story “Natural Breasts.” Of course, for the magazine it’s a great title because it allows for the rationale to make the cover photo a close-up of a woman’s cleavage which is probably good for a little spike in sales to their predominantly male (and perhaps nerdy) readership.
What is Wired referring to when they refer to “natural breasts?” The story talks about the renewed interest in fat grafting as an option for breast augmentation. Fat grafting for breast augmentation means plumping up a woman’s breasts with her own fat that is transferred from another part of her body rather than using silicone or saline breast implants. Just the other day I posted a press release that highlighted a recent study I took part in that showed the VASER liposuction system is ideal for this very purpose. Essentially, the story is the tale of a bio-tech start-up company called Cytori. This company is getting into the tissue engineering business via stem cells harvested from fat and are doing so by starting with breast augmentation.
Why breasts? Theoretically they are simple to build since they consist of only one type of tissue which is fat. Nobody’s talking about actually building mammary glands that secrete milk. It’s all about form and not function. Attempts were made beginning in 1980s to do augmentation with fat. They had mixed results, mostly due to the fat not surviving and just being absorbed by the body. There were many different techniques and many different technologies applied.
This new story begins with a UCLA plastic surgeon Mark Hedrick who wondered if fat had stem cells. In fact it does. Approximate one stem cell per 100 fat cells versus one per 250,000 to 400,000 in bone marrow. Stem cells are the darlings of cell biology. Theoretically they can be used to make any tissue. They also release substances which improve healing and regeneration. Cytori reasoned that if you separated stem cells from the fat, purify them and added them as a concentrated extract to more fat than the combined stem cell plus fat graft would take better. They ran two successful trials in Japan. One on reconstructing partial mastectomy another on breast augmentation. I actually have the opportunity to hear the investigator Dr. Karushima present his work. He successfully implanted approximately 100 mL per breast for an increase of 1.6 cupsizes his Japanese patients.
The rest of the article talks about the potential for these stem cells including heart and other organs. So is this the next big thing? Well it certainly could be for the hard if their studies continue to pan out.
Why isn’t this a done deal? There are many questions with respect to breast augmentation with fat grafting. The following are just a few:
- The results are not significantly different than non-stem cell fat grafting to the breast. I’ve done in the past on selected patients with good results. Dr. Coleman in New York and Dr. Khouri in Florida have achieved excellent results without stem cells. To date I don’t know of any study comparing stem cell fat grafting with non-stem cell fat grafting.
- Caution needs to be used for the mastectomy reconstructions. In animal studies stem cells can potentiate cancer growth. Now there has already been a lot of work with fat grafting to breast cancer reconstruction. No problems have been reported. However is there a critical mass of stem cells that might cause a cancer recurrence?
- What are the comparative costs going to be? Taking time to remove enough that can be a long procedure, adding to anesthesia expenses and increasing patient risk. As long as we’re taking out these cells and manipulating them why not have an ideal scenario where you take out 10 CC a fat in the office under local and grow to 1000 CC in the lab and then inject?
- Who will be doing this? Anybody they can buy cytoris stem cell machine? Building a breast is an art as well as a science we’ve already seen the problems when non-core physicians, that is, family practitioners and gynecologists get into the plastic surgery profession.
- There is currently a limit on how much fat can be put in. This is related to the skin tightness and pressure which kills fat grafts themselves when too much is put in. Dr. Khouri has solved this problem for now with skin expansion using the Brava bra but this is time-consuming and burdensome. If the cells are augmented with the Cytori stem cell technique can this be avoided?
So are stem cells really the answer to natural breast augmentation? Cytori is certainly betting a lot of money that it is. Hopefully their studies will show that stem cells and fat grafts will create an easy breast augmentation with minimal downtime and no future complications that is superior to current techniques. If not someone else will eventually come up with the answer. Tissue engineering is already here. It’s just not perfected. So stay tuned it’s going to be a wild ride!