Options for Regenerative Therapy in the Field of Breast Surgery

Besides the established techniques of pediculed and free tissue transplantations for breast reconstruction, adipose tissue engineering and structural fat grafting are being applied as options for regenerative therapy. While the initial euphoria about the foreseeable realisation of cell-matrix entities of sufficient size, functionality and long-term volume stability for use in humans has diminished somewhat, fat grafting as experienced a renaissance in recent years. One of the decisive factors for the engraftment of the tissue graft generated though tissue engineering is the formation of an adequate vascular network. Improvements of the matrix, which ideally should mimic natural tissue, such as the use of adipose-derived stem cells (ASCs) that can contribute both to adipogenesis and neoangiogenesis represent promising new approaches. In autologous fat grafting, the mixing of adipocytes and cells of the stromal-vascular fraction (SVF) in order to generate the principle of an inductive microenvironment has already been applied successfully in clinical routine. On the basis of the experimental data that demonstrate an interaction of the adipocytes, ASCs and other progenitor cells with breast cancer cells and the insufficient clinical data regarding oncological safety, this procedure should only be used critically. A concluding evaluation will only be possible after long-term clinical studies have provided good results.