幹細胞脂肪注入による豊胸術について詳しいサイトやリスクを知りたいです。美容外科のホームページは自分で調べられるのでそれ以外で情報をお願いいたします。

その道の専門家ではないので、幹細胞脂肪注入というのが一つの確立された方法なのかどうか、

種類がいくつもあるのかどうか知りません。

pubmedという医学文献を探せるサイトで、豊胸と幹細胞をキーワードで探して、質問の回答の参考になりそうな二つを紹介します。

http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed

個人的な感想では、きっとまだ完全には確立されていない分野です。自己の幹細胞を注入するのだと思いますが、

一般的に考えられるリスクとしては、下記文献にあるように、注入しても容量が減ってしまう、石灰化が起きる、結果が予測できない。

壊死が強ければ炎症も起きるでしょう。

また、長期的には幹細胞を移植するので発癌のリスクなども考えないといけないと思います。

下記文献のポイントを超省略して要約すると、

一つ目の文献

豊胸術にはシリコンが使われて来たが、問題が多かった（拒絶反応を起こしたり、取り除いた時に傷が残るなど）。

自己脂肪組織の移植は豊胸術以外の手術でも良く使われ、拒絶反応もなく良い結果を出している報告が多数ある。

ところが、著者らが行うと、合併症が多く、移植しても脂肪組織が吸収されてしまった。

そこで著者らは新しい方法を開発し、1998年から300の乳房に160-685(平均325ml)の培養した脂肪を移植した。

合併症は、微小石灰化等で少なかった。注入脂肪には、成人間葉全能幹細胞が含まれている。

二つ目の文献　（これは日本からですね）

脂肪移植は予測できず、移植した組織が壊死してしまう問題があった。

そのため、ASCsという方法を一緒に用いて、脂肪注入をした。

４０人の患者に行った結果、270mlの脂肪を注入し、100-200mlのボリューム増強効果があった。

術後２か月の観察で、容量の縮小は少なかった。

嚢胞形成や微小な石灰化が４人の患者で副作用として認められた。

ほとんどの患者は、自然な感じの豊胸術に満足していた。

1: Aesthetic Plast Surg. 2008 Mar;32(2):313-28. Links

Bicompartmental breast lipostructuring.

Zocchi ML, Zuliani F.

CSM Institute for Aesthetic Plastic Surgery, 4, via Guarini, Torino 10123, Italy. michelezocchi@michelezocchi.com

The techniques of additive mastoplasty described over the years require the use of alloplastic materials (silicon), which often are poorly tolerated by the body and need access paths that could leave visible, unaesthetic residual scars. Furthermore, the controversy over silicone gel-filled breast implants, which in the early 1990s restricted their clinical use for primary cosmetic breast augmentation, still raises concerns in some patients.

The authors therefore felt encouraged to search for alternatives to breast implants and reconsider fat transfer. In fact, for almost a century, autologous adipose tissue has been used safely and with success in many other surgical fields for the correction of volumetric soft tissue defects. Its natural, soft consistency, the absence of rejection, and the versatility of use in many surgical techniques have always made autologous adipose tissue an ideal filling material. In the past, the authors used this technique, as originally described by Fournier (intraparenchymal, en bloc injection), for 41 patients.

However, disappointed by a very high rate of complications and the almost complete reabsorption of the grafted fat, they quit using the procedure. An extensive literature review indicated that the complications observed were related only to technical errors and to the anatomic site of harvesting and implantation.

The authors therefore developed a new method incorporating recent contributions in functional anatomy and fat transfer. Fat is harvested in a rigorously closed system, minimally manipulated, and reimplanted strictly in two planes only: into the retroglandular and prefascial space and into the superficial subcutaneous plane of the upper pole of the breast (bicompartmental grafting). Any intraparenchymal placement is carefully avoided. Since 1998, 181 patients (300 breasts) have undergone this procedure.

Grafted fat volume has ranged from 160 to 685 ml (average, 325 ml) per breast. Complications have been minimal and temporary. All patients have been carefully monitored with preoperative and serial postoperative mammograms and ultrasonograms. This strict follow-up assessment allowed the authors to clarify the controversial aspect of microcalcifications, the main point of criticism for this procedure over the years. Microcalcifications can occur in response to any trauma or surgery of the breast, but are very different in appearance and location. Thus, they can be discriminated easily from those appearing in the context of a neoplastic focus. Probably the most important point is that the fat survival ranged from 40% to 70% at 1 year. The volume is maintained because when the authors transplant living fat tissue, they also transfer a consistent amount of adult mesenchymal stem cells that spontaneously differentiate into preadipocytes and then into adipocytes, compensating for the partial loss of mature adipocytes reabsorbed through time. This theory has been well demonstrated via advanced research performed by the authors and by many other prominent medical institutes worldwide. The findings show that adipose tissue has the same potential for growth of adult mesenchymal totipotential stem cells of bone marrow and can eventually be differentiated easily by the use of specific growing factors and according to the needs and applications in other cellular lines (osteogenic, chondrogenic, myogenic, epithelial). In summary, the authors wish to highlight a formerly controversial procedure that, thanks to recent technical and clinical progress, has become a safe and viable alternative to the use of alloplastic materials for breast augmentation for all cases in which additive mastoplasty with implants is either unsuitable or unacceptable by the patient herself. However this method cannot be considered yet as a complete substitute for augmentation with implants because the degree of augmentation and projection still is limited.

PMID: 18188638 [PubMed - indexed for MEDLIN

Aesthetic Plast Surg. 2008 Jan;32(1):48-55; discussion 56-7. Epub 2007 Sep 1. Links

Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells.

Yoshimura K, Sato K, Aoi N, Kurita M, Hirohi T, Harii K.

Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan. yoshimura-pla@h.u-tokyo.ac.jp

BACKGROUND: Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. METHODS: To overcome the problems with lipoinjection, the authors developed a novel strategy known as cell-assisted lipotransfer (CAL). In CAL, autologous adipose-derived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. RESULTS: Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. CONCLUSIONS: The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.

PMID: 17763894 [PubMed - indexed for MEDLINE]