As early as 1896, the German physician Dr. NEUBER successfully transplanted the patient's fatty tissue into a different body site of the same patient where a defect had been caused by an accident. In 1910, an almost 300-page paper on fat transfer from Dr. LEXER appeared. In the time between the world wars, it became quiet around this method. It was not until the seventies that the transfer of own adipose tissue was resumed in the USA, and especially the doctors SHIFFMAN and COLEMAN have made a particular contribution.
In Germany it is probably Professor PALLUA, from the RWTH Aachen, who initiated the most scientific work in this field.
With regard to the breast augmentation with its own adipose tissue, there were up to about 2005 more depths than heights. Only in the last few years has it been understood which basic conditions have to be considered so that the fatty tissue is not damaged during the removal and the composition of the other components is not significantly changed. It is therefore important how the adipose tissue which is to be sucked is pre-treated by the anesthetic solution, the size of the perforations of the suction cannula, the vacuum which prevails during suction, and how fast the cannula moves. The aspirate must be washed to reduce inflammation-mediating cells and the fibrous tissue must be gently removed from the adipose tissue without injury to the adipocytes. Depending on the further use, the fat cells are mechanically ruptured so that the oil can be centrifuged off. Everything is done under extremely sterile conditions, which is only possible in the clean room laboratory with laminar, Hepa filtered airflow, existent in the Medical Well Clinic Dresden.
The transfer of the adipose tissue into the breasts is difficult because small fat droplets have to be evenly distributed. Here a special machine is used which, on the one hand, serves the fine distribution of adipose tissue and, on the other, shortens surgery for the benefit of the patient. If the fatty tissue is only simply injected, oil cysts can develop, which always lead to discomfort from a certain size. These are important work steps in the process of fat tissue production, processing and application. There are other factors that need to be considered, still.
In the processing of the adipose tissue obtained for further use in the same patient, there is a trend away from the (1) enzymatic, chemical separation of the regeneratively active cells from the adipose tissue (here, considerable regulatory hurdles have to be overcome) to (2) little manipulative, purely physical processing.
In the 1st method one runs the risk that the isolated stem cells lead their uncontrolled self-life and for example emigrate from the actual target area and withdraw themselves from further control. In addition, there have been increased scarring in the target area. To this extent, the legislator is right to apply strict standards here. Also, the admixture of these chemically dissolved stem cells to the normal fatty tissue (so-called "enhanced fat") has not brought any gain in breast enlargement, only more valuable adipose tissue consumed (according to a prize-winning study by Dr. PELTONIEMI, University of Helsinki).
In contrast, in the 2nd method, the regeneratively active cells (stromal vascular fraction) remain within their niche, consisting of extracellular matrix, providing intercellular communication, and are controlled by this in their further behavior. The adipose tissue is only micronized, but remains essentially retained with approximately 90% of its cells in its composition. The stem cells do not migrate from their niche and behave along natural signals from their surroundings in the target area.
At the Medical Well Clinic Dresden, adipose tissue transfers have been carried out since 2002. Since 2009, we have been working intensively on the fast-growing biotechnological insights and scientific results. This led to the installation of a clean room lab in the operation line in 2012. For nearly 5 years (as of May 2017), we are able to reproduce validated scientific studies in our laboratory and are thus always up-to-date in our daily practical application. Without having to undertake costly examinations and laborious investigations, we know from the scientific literature exactly how the tissue cells to be transferred are composed in numbers. We can observe all factors that lead to a maximal acceptance of the transmitted tissue cells. Permanent volumes (eg, in breast enlargements) of about 70-80% of injected substance are often possible. The present description represents the current standard.
A current research topic is the bacteria-free inflammation reaction, which prevents a better growth of the transferred tissue parts. There are already approaches to solving this problem.
We review the latest scientific literature every month.
In the medium term, women who have little adipose tissue and thus few regenerative cells will be able to achieve an even better volume result by applying a vacuum before and after surgery. This will make the number of women who have previously required a breast implant smaller.
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Dr. med. Michael Meinking
Senior physician of the Medical Well Clinic Dresden