A comparative translational study: the combined use of enhanced stromal vascular fraction and platelet-rich plasma improves fat grafting maintenance in breast reconstruction

Abstract

The use of autologous fat grafting is ideal in breast reconstruction. However, published data on long-term outcomes and instrumental results of fat grafting to the breast are lacking. The purpose of this study was to review the authors' experience of fat grafting, evaluating the effects related to the use of enhanced stromal vascular fraction (e-SVF) and fat grafting with platelet-rich plasma (PRP) in the maintenance of fat volume in breast reconstruction, comparing the results with a control group. Twenty-three patients aged 19-60 years affected by breast soft tissue defects were analyzed at the Plastic and Reconstructive Department of the University of Rome Tor Vergata. Ten patients were treated with SVF-enhanced autologous fat grafts, and 13 patients were treated with fat grafting + platelet-rich plasma. The patients in the control group (n = 10) were treated with centrifuged fat grafting injection according to Coleman's procedure. The patients treated with SVF-enhanced autologous fat grafts showed a 63% maintenance of the contour restoring and of three-dimensional volume after 1 year compared with the patients of the control group treated with centrifuged fat graft, who showed a 39% maintenance. In those patients who were treated with fat grafting and PRP, we observed a 69% maintenance of contour restoring and of three-dimensional volume after 1 year. As reported, the use of either e-SVF or PRP mixed with fat grafting produced an improvement in maintenance of breast volume in patients affected by breast soft tissue defect.

Figure 1.

Breast reconstruction with fat graft + platelet-rich plasma. (A): Preoperative in frontal projection. (B): Postoperative in frontal projection after 1 year. (C): Preoperative in ¾ right projection. (D): Postoperative in ¾ right projection after 1 year.

Figure 2.

Patients treated with stromal vascular fraction-enhanced autologous fat grafts. (A): Preoperative in frontal projection. (B): Postoperative in frontal projection after 1 year. (C): Preoperative in ¾ right projection. (D): Postoperative in ¾ right projection after 1 year.

Figure 3.

Magnetic resonance imaging of a patient treated with enhanced stromal vascular fraction fat grafting. (A, B): T2 imaging (A) and T2 SPAIR imaging (B) of the preoperative situation. Arrows show the critical point of the reduced thickness, the lines show the reduced thickness of the tissue, and the circles show the local soft tissue defect characterized by a loss of volume. (C, D): T2 imaging (C) and T2 SPAIR imaging (D) of the postoperative situation after 1 year. Arrows show the improvement of the critical point, the lines show the increased thickness of the tissue, and the circles show the correction of the local soft tissue defect with maintenance of volume. Abbreviation: SPAIR, spectral attenuated inversion recovery.

Figure 4.

Magnetic resonance imaging of a patient treated with fat grafting mixed with platelet-rich plasma. (A, B): T2 imaging (A) and T2 SPAIR imaging (B) of the preoperative situation. Circles show the critical point of the reduced thickness, the yellow arrows show the reduced thickness of the tissue in the critical point, and the red arrows show the normal soft tissue thickness near the defect. (C, D): T2 imaging (C) and T2 SPAIR imaging (D) of the postoperative situation after 1 year. Circles show the absence of the critical point with a completely correction of the defect, yellow arrows show the increased thickness of the tissue and maintenance of fat volume in the critical point, and red arrows show the augmentation of soft tissue volume. Abbreviation: SPAIR, spectral attenuated inversion recovery.

Figure 5.

Adipogenic and osteogenic differentiation of adipose-tissue-derived stem cells (ASCs). (A, B): Oil Red O staining of control ASCs (Dulbecco's modified Eagle's medium [DMEM] + 10% fetal bovine serum [FBS]) (A) and ASCs after induction of adipocyte differentiation (B). (C, D): Nuclei were counterstained with hematoxylin and von Kossa staining in control ASCs (Dulbecco's modified Eagle's medium [DMEM] plus 10% fetal bovine serum [FBS]) (C) and ASCs after induction of osteogenic differentiation (D). Nuclei were counterstained with Fast Red. (E, F): Contrast phase micrographs showing the similar morphological appearance of control and PRP-treated cells. Magnification, ×100. (G): Growth curve of control (DMEM + 10% FBS) and PRP-treated ASCs (DMEM + 10% FBS + 5% PRP) showing an increase of cell number with PRP treatment (∗, p < .02; t test). (H, I): Oil Red O staining of control and PRP-treated ASCs showing a similar intracytoplasmic accumulation of small lipid droplets in both groups. Magnification, ×100. Abbreviations: ctr, control; PRP, platelet-rich plasma.

Figure 6.

Clinical evaluation of fat graft volume maintenance in breast restoration. Abbreviations: PRP, platelet-rich plasma; SVF, stromal vascular fraction.

Figure 7.

Effect of platelet-rich plasma on stromal marker expression in human adipose-derived stem cells. (A, B): Flow cytometry (A) and percentages of stromal markers CD90 and CD44 positivity (B) in serum control PRP (5% vol/vol) for 6 days. (C): Blot analysis of CD90 and CD44 protein in serum control PRP (5% vol/vol) for 6 days. (D): Densitometric analysis of CD90 and CD44 protein expression after blotting. Abbreviations: ADU, arbitrary densitometric units; CTR, control; PRP, platelet-rich plasma.