الفهرس 
Adipose tissueOnly 14 pages are availabe for public view
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Abstract
Autologous fat transplantation is the most promising treatment for breast enhancement but it has its complications such as unpredictability and low survival rate due to fat necrosis and calcification due to insufficient blood supply to the grafted cells.
The use of adult stem cells (ASCs) harvested from the adipose tissue shows a great benefit on the graft survival due to their capabilities of angiogenesis.
Controlled prospective study on 40 patients divided into two groups, aged between 21 and 60 years old whom desired moderate increase in the breast volume. The first group “control / Non-CAL group” were grafted by traditional technique of fat grafting, with low adipose derived stem cells content, the second group “Experimental group” were grafted with fat enriched with adipose derived stem cells through the use of cell assisted lipotransfer technique (CAL). The volume of fat grafted was in an average of 250 -350 cc.
They were assisted pre and postoperatively by physical measurements, Photographic documentation, radiological through the use of mammography to detect any calcifications or cysts. All patients’ breast volume were objectively assisted and the volume changes were calculated through the measurements taken by both mammography (Kalbhen formula), water displacement, and corrected by Magnetic resonance imagining (MRI) preoperatively and at 3, 6 months postoperatively.
Determination of the presence of adipose derived stem cells (ASCs) was performed by (1) the morphological identification in 10-15 days culture period as being a small cell body with a few cell processes that are long and thin. (Fibroblast like), (2) being CD34+ antibodies positive.
Final breast volume showed augmentation with a preserved fat of an average 250-270cc postoperative. Cytometric analysis revealed that the adipose-derived stromal cells were positive for mesenchymal cell markers.
The CAL ”experimental group” had a statistically significantly better grafted volume than those from the control group. Partial loss and asymmetry was reported in the two groups and another session of fat injection was needed in 4 patients.
Objective evaluation based on the personal satisfaction of the final results showed no superiority of any technique more than other regarding the shape and volume. Breast enhancement with fat grafting showed a more natural contour without too much increase in the projection, especially when applied with young patients with tight skin envelope.
Age was considered as an important factor influencing the results regardless the technique used, fat resorption and decrease in breast volume was greater in patients aged more than 40 years old, which was confirmed by ultrasound evaluation and volume assessment.
Focal small regions of fat necrosis was encountered in 3 cases (2 cases of the control group & a case of the CAL group). No malignant transformation was detected along 6 months follow up in all patients underwent breast fat grafting.
Finally, the use of adipose derived stem cells in fat grafting (CAL) is effective and safe mean for breast augmentation, but to maximize the results special attention should be given to (1) Good patient selection (Age (better younger than 40 years old), having a sufficient fat at donor sites, sufficient and healthy skin envelope, and having a reasonable expectations), (2) The method of harvesting and way of injection of fat to maximize the graft survival.
Long term studies and a longer follow up are needed to investigate the fate of the injected fat and the ASCs behavioural changes in the breast and possible complications that may occur.