Breast reconstruction using the patient’s own fat cells

Jamilla Wederfoort and Maud Rijkx

Breast reconstruction using the patient’s own fat cells

The societal impact of UM research

10-01-2024 · Interview

In today’s world, the societal impact of research findings seems more important than getting published in an academic journal like Nature or The Lancet. What impact has research conducted at UM had in recent years? This week: how a UM study paved the way for a new method of breast reconstruction after cancer.

A mastectomy is a way to treat breast cancer by surgically removing a breast. Some patients undergoing this procedure choose to have the other breast removed as a precaution. And some patients who need a partial mastectomy decide, in consultation with their doctor, to play it safe and have the entire breast removed, explains researcher Maud Rijkx. “There are also women who decide to have a preventive mastectomy after discovering they are genetically at higher risk of breast cancer.”

In the Netherlands, about one in seven women will develop breast cancer during their lifetime—almost twenty thousand each year, says Jamilla Wederfoort, who is training to be a plastic surgeon at MUMC+. Like Rijkx, she did her PhD research on breast reconstruction. Both are part of the UM BREAST trial team. “Of those twenty thousand women with breast cancer, an estimated seven thousand undergo total mastectomy.”

Scar

For years, there were two main types of breast reconstruction: tissue-based reconstruction using the patient’s own body tissues, such as the DIEP flap procedure, or implant reconstruction. Many patients opt for DIEP flap surgery, which uses tissue taken from the abdomen. Wederfoort: “Many see it as a win-win—a flatter belly and a new breast. Patients who are not candidates for DIEP flap surgery because they’re too thin, for example, can opt for a silicone implant. The advantage of implant reconstruction is that it’s a shorter surgery with less scarring.”

However, both techniques have such serious drawbacks that some women opt for no reconstruction whatsoever. Wederfoort: “Implants are foreign objects in your body. They may rupture or leak over time, resulting in additional surgery. DIEP flap surgery is taxing; it can take up to ten hours and there is a risk of serious complications. It also leaves a large scar on the abdomen.”

Lipofilling

Enter a third option: lipofilling. This method of breast reconstruction was introduced in the Netherlands by the BREAST research team and tested in collaboration with other medical centres. Lipofilling also uses the patient’s own body tissues by extracting fat cells from the abdomen, legs or back and injecting them into the breast.

The technique has distinct advantages, says Rijkx. “It leaves minimal scarring, patients can go home the same day and recovery typically takes about two weeks.”

But one question remains. Why does half of the injected fat disappear? “It partly dissolves, which is not unusual. We’re currently trying to find out why some patients retain more fat tissue than others. Is it related to body weight, age, smoking?”

Plastic surgeons were already using lipofilling in cosmetic procedures, but its use in total breast reconstruction is relatively new. In a study, UM researchers compared 91 women undergoing lipofilling with 80 women undergoing implant reconstruction. The lipofilling group turned out to be more satisfied with their new breasts and felt better physically. The technique was also found to be safe. Ongoing UM research is focused on fine-tuning the method.

Training

The new method hasn’t gone unnoticed. The list of hospitals offering lipofilling as a breast reconstruction option continues to grow, says Rijkx. “Five more centres joined this year, bringing the total to thirteen. Plastic surgeons in all thirteen institutions have been trained in the technique.”

As of this year, the method is covered by health insurance under certain conditions. Wederfoort: “Patients must not have undergone radiation therapy, which damages blood vessels and leaves scar tissue, hindering fat tissue growth. Smoking and excessive weight also disqualify patients from the surgery.”

Some patients find the method demanding, as they must wear a vacuum-based device on their chest for two weeks before and after the surgery to improve fat tissue survival.

It’s unknown how many patients in the Netherlands have opted for breast reconstruction using lipofilling this year. Wederfoort: “To give you an idea, a third of the seven thousand women who undergo total mastectomy opt for breast reconstruction. Part of that group opts for lipofilling. So we’re not talking about thousands of women yet, but that may only be a matter of time.”

Photo: Ellen Oosterhof

Categories: news_top, Science
Tags: impact,societal impact,breastcancer,BREAST,lipofilling

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