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(Department of Plastic Surgery, Medical Centre of Postgraduate Education, Warsaw, Poland)
Ann Transplant 2015; 20:526-531
Over the last decade autologous fat from subcutaneous tissue has been used by plastic surgeons for face volumization. It has also been used with growing frequency for aesthetic breast enhancement. Currently, experts in this field are becoming increasingly aware of the potential of fat for breast reconstruction. However, the safety of fat transfers to post-mastectomy defects has been called into question in recent debates due to the, albeit rare, observations of their possible influence on local cancer recurrence. The majority of concerned opinions are based on the safety of fat supplementation with additional amounts of adipose mesenchymal and stem cells. In experimental conditions, these cells were shown to create pathophysiological microenvironments and promote neoplastic transitions. This raises the question as to whether breast reconstruction with enriched fat is sufficiently safe to be performed without scientific justification and whether the present legal regulations are sufficient to guarantee patient safety in small facilities. In a number of circumstances, patients who have undergone treatment in profit-oriented offices, outside the system of oncological or surgical centers, might have been left without any long-term cancer surveillance. Valid opinions have also been expressed on the grounds of the ethical doubts concerning the advertising used by cosmetic practitioners who, on occasion, tend to overemphasize the putative benefits of stem cell applications despite the scant support in evidence-based medicine. Real progress in this field is possible only in scientific research that relies on bioethical evaluation, properly planned clinical trials, and the judgment of peers.
Keywords: Adipose Tissue, Mammaplasty, Stem Cell Transplantation