Doctors use stem cells from fat to fix breasts after surgery
By MARILYNN MARCHIONE AP Medical Writer
© 2007 The Associated Press
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SAN ANTONIO — For the first time, doctors have used stem cells from
liposuctioned fat to fix breast defects in women who have had
cancerous lumps removed.
The approach is still experimental, but holds promise for millions of
women left with cratered areas and breasts that look very different
from each other after cancer surgery. It also might be a way to
augment healthy breasts without using artificial implants.
So far, it has only been tested on about two dozen women in a study
in Japan. But doctors in the United States say it has great potential.
"This is a pretty exciting topic right now in plastic surgery," said
Dr. Karol Gutowski of the University of Wisconsin-Madison. "There are
people all over the country working on this."
The Japanese study was reported Saturday at the San Antonio Breast
Cancer Symposium. The company that developed the treatment, San Diego-
based Cytori Therapeutics, plans larger studies in Europe and Japan
next year.
More than 100,000 women have lumps removed each year in the United
States. These operations, lumpectomies, often are done instead of
mastectomies, which take the whole breast. But they often leave
deformities because as much as a third of a woman's breast may be
removed.
"It's almost a euphemism" to call it a lumpectomy, said Dr. Sydney
Coleman, a plastic surgeon at New York University who has consulted
for Cytori and is interested in the stem cell approach.
The defect "initially may not be as noticeable" but it often gets
worse, especially if the woman also has radiation treatment, said Dr.
Sameer Patel, a reconstructive surgeon at Fox Chase Cancer Center in
Philadelphia.
"There's a growing push to try to involve the plastic surgeon
particularly for this reason — to try to avoid a defect," but once
one develops, options to repair it are limited, Patel said.
The implants sold today are for reconstructing breasts after
mastectomies. They aren't designed to fix odd-shaped deformities from
lumpectomies or radiation.
"Each one is so different, there's no little thing you can just pop
in there," Gutowski explained.
Doctors can try making the other breast smaller so they match,
transplanting a back muscle to boost the flawed breast, or
rearranging tissue to more evenly distribute what's left. But these
involve surgery and leave scars.
Mini implants of fat tissue have been tried, but they often get
resorbed by the body or die and turn hard and lumpy. The recent
discovery that fat cells are rich in stem cells — master cells that
can replenish themselves and form other tissues in the body — renewed
interest in their use.
In the Japanese study, doctors liposuctioned fat from 21 breast
cancer patients' tummies, hips or thighs. Half was reserved as the
main implant material; the rest was processed to extract stem cells
and combined with the reserved fat. This was injected in three places
around a breast defect.
Doctors think the stem cells will keep the tissue from dying and form
lasting mini implants.
Eight months after treatment, "about 80 percent of the patients are
satisfied" with the results, said the lead researcher, Dr. Keizo
Sugimachi of Kyushu University in Fukuoka, Japan.
There was a statistically significant improvement in breast tissue
thickness at one and six months after treatment.
Doctors with no role in the research say longer study is needed to
see if these results last.
The treatment is expected to cost $3,000 to $5,000, said Cytori's
president, Dr. Mark Hedrick. The company sees potential for cosmetic
breast augmentation of healthy breasts, but for now "our plan is to
focus on an unmet medical need" in cancer patients, he said.
The American Society of Plastic Surgeons says doctors must be
cautious about using fat cells for cosmetic purposes until more is
known. Gutowski heads a task force the society formed to study the
science. Coleman is a member.
"It's got great potential not only for breast but other cosmetic and
reconstructive purposes," like filling in facial defects from cancer
or trauma, Gutowski said. "Imagine the aging face."
Better cosmetic treatments may encourage more women to choose
lumpectomies. Some have opted for mastectomies because they are
concerned about being left with a defect, especially younger women.
Laurie Rapp, a 48-year-old restaurant manager in Philadelphia, was
only 32 when she had a lumpectomy, and now has mismatched breasts.
"One is so much smaller than the other one," she said. "There's quite
a bit of puckering, and as I'm getting older I feel it's getting
worse."
She probably would not try the stem cell treatment now, but if it had
been available when she had her surgery, "I definitely would have,
especially because I wasn't even married then," she said.
___
On the Net:
Breast cancer meeting: http://www.sabcs.
National Cancer Institute: http://www.cancer.
Cytori: http://www.cytoritx
http://www.chron.
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Children's Neurobiological Solutions
http://www.CNSfoundation.org/
Cord Blood Registry
http://www.CordBlood.com/at.cgi?a=150123
The CNS Healing Group
http://groups.yahoo.com/group/CNS_Healing
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