Autologous bone-marrow-derived-mononuclear-cells-enriched fat transplantation in breast augmentation: evaluation of clinical outcomes and aesthetic results in a 30-year-old female

Abstract

Autologous fat transfer (lipofilling) is becoming an invaluable tool for breast augmentation as well as for breast reconstruction. Autologous lipofilling has several advantages, including biocompatibility, versatility, natural appearance, and low donor site morbidity. The main limitation is unpredictable fat graft resorption, which ranges from 25% to 80%, probably as a result of ischaemia and lack of neoangiogenesis. To obviate these disadvantages, several studies have searched for new ways of increasing the viability of the transplanted fat tissue. One promising approach is to enrich the fat graft with autologous bone-marrow-derived mononuclear cells (BMMNCs) before transplantation. BMMNCs produce many angiogenic and antiapoptotic growth factors, and their secretion is significantly enhanced by hypoxia. All of these mechanisms of actions could be beneficial for the stimulation of angiogenesis in ischemic tissues by BMMNCs administration. In our aesthetic surgery practice, we use fat transplantation enriched with BMMNCs, which caused a significant improvement in survival of fat grafts, compared with that of traditional lipofilling. Our experience with freshly isolated autologous fat enriched with BMMNCs for breast augmentation procedures is presented. The concept of this surgical and tissue handling technique is based on ability of BMMNCs to stimulate blood vessel growth.

Figure 1

Bone-marrow-derived mononuclear cells preparation: (a) the bone marrow harvesting from posterior iliac crest, (b) collection of bone marrow in plastic bag, (c) the bone marrow processing by using Cell Separation System SEPAX S-100, and (d) qualitative assessment of BMMNCs population by haematoxylin and eosin cytological staining (×400).

Figure 2

Purified fat and BMMNCs mixture preparation: (a) the harvested fat after tumescent syringe liposuction, (b) the purified fat in Cytori PureGraft 250/PURE System, and (c) the BMMNCs and purified fat mixture transferring to 10 mL syringe.

Figure 3

Purified fat and BMMNCs mixture reimplantation: (a) and (b) breast augmentation procedure (bicompartmental grafting).

Figure 4

Clinical outcomes and aesthetic results after BMMNCs-enriched lipograft for primary bilateral breast augmentation: preoperative views (top), and postoperative views at 14 days (middle), postoperative views at 12 months (bottom); (A) right view, (B) front view, and (C) left view.