DESCRIPTION
Autologous fat grafting to the breast, using adipose-derived stem cells (ADSCs), is proposed as an adjunct to reconstructive breast surgery. Stem cells, because of their pluripotentiality and unlimited capacity for self-renewal, offer promise for tissue engineering and advances in reconstructive procedures. In particular, adipose tissue represents an abundant and easily accessible source of ADSCs which can differentiate along multiple mesodermal lineages. Differentiation into adipocytes may provide a reservoir for adipose tissue turnover, while differentiation into endothelial cells, with the release of angiogenic growth factors, may decrease the rate of graft resorption by increasing blood supply to the grafted fat tissue.
Although adipose-derived stem cells could play a role in graft survival through adipogenesis, a complete understanding of the mechanisms of interactions among adipose stem cells and growth factors is lacking. Questions related to isolation, harvesting and purification of adipose-derived stem cells, their effect on cancer cell growth and their long-term efficacy remain.
POLICY
The use of adipose-derived stem cells in autologous fat grafting to the breast is considered investigational.
IMPORTANT REMINDERS
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ADDITIONAL INFORMATION
The evidence for the use of adipose-derived stem cells in individuals with breast cancer who are undergoing autologous fat grafting to the breast includes small single-arm studies, some of which are prospective. Limitations of the data are small numbers of participants, short-term follow-up, and lack of understanding of the possible oncologic influence adipose-derived stem cells may have on the fat grafting procedure. The evidence is insufficient to determine the effects of this technology on health outcomes.
SOURCES
American Society for Aesthetic Plastic Surgery/American Society of Plastic Surgeons. (2011). Joint ASPS & ASAPS position statement: Stem cells and fat grafting. Retrieved January 11, 2017 from www.plasticsurgery.org.
BlueCross BlueShield Association. Evidence Positioning System. (2:2023). Adipose-derived stem cells in autologous fat grafting to the breast. (7.01.153). Retrieved August 9, 2023 from http://www.evidencepositioningsystem.com. (9 articles and/or guidelines reviewed)
Charvet, H., Orbay, H., Wong, M. & Sahar, D. (2015). The oncologic safety of breast fat grafting and contradictions between basic science and clinical studies: a systematic review of the recent literature. Annals of Plastic Surgery, 75 (4), 471-479. Abstract retrieved January 11, 2017 from PubMed database.
Jeon, H., Choi, D., Lee, J., Lee, J., Lee, J., Park, H., & et al. (2021). A prospective study of the efficacy of cell-assisted lipotransfer with stromal vascular fraction to correct contour deformities of the autologous reconstructed breast. Aesthetic Plastic Surgery, 45 (3), 853–863. Abstract retrieved August 9, 2023 from PubMed database.
Laloze, J., Varin, A., Gilhodes, J., Bertheuil, N., Grolleau, J.L., Brie, J., et al. (2018). Cell-assisted lipostransfer: friend or foe in fat grafting? Systematic review and meta-analysis. Journal of Tissue Engineering and Regenerative Medicine, 12 (2), e1237-e1250. Abstract retrieved November 12, 2019 from PubMed database.
National Institute for Health and Care Excellence. (2012). Breast reconstruction using lipomodelling after breast cancer treatment. Retrieved January 11, 2017 from www.nice.org.uk/guidance/ipg417.
Simonacci, F., Bertozzi, N., Grieco, M., Grignaffini, E. & Raposio, E. (2016) Autologous fat transplantation for breast reconstruction: A literature review. Annals of Medicine and Surgery. 12, 94-100. (Level 2 evidence)
Toyserkani, N., Jørgensen, M., Tabatabaeifar, S., Jensen, C., Sheikh, S., & Sørensen, J. (2017). Concise review: a safety assessment of adipose-derived cell therapy in clinical trials: a systematic review of reported adverse events. Stem Cells Translational Medicine, 6 (9), 1786-1794. Abstract retrieved November 22, 2017 from PubMed database.
Waked, K., Colle, J., Doornaert, M., Cocquyt, V., & Blondeel, P. (2017). Systematic review: the oncologic safety of adipose fat transfer after breast cancer surgery. Breast, 31, 128-136. Abstract retrieved November 22, 2017 from PubMed database.
ORIGINAL EFFECTIVE DATE: 1/10/2015
MOST RECENT REVIEW DATE: 9/14/2023
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