Introduction: Autologous fat grafting is commonly used to correct soft-tissue contour deformities. However, results\nare impaired by a variable and unpredictable resorption rate. Autologous adipose-derived stromal cells in combination\nwith lipoinjection (cell-assisted lipotransfer) seem to favor a long-term persistence of fat grafts, thus fostering the\ndevelopment of devices to be used in the operating room at the point of care, to isolate the stromal vascular fraction\n(SVF) and produce SVF-enhanced fat grafts with safe and standardized protocols. Focusing on patients undergoing\nbreast reconstruction by lipostructure, we analyzed a standard technique, a modification of the Coleman�s procedure,\nand three different commercially available devices (Lipokit, Cytori, Fastem), in terms of 1) ability to enrich fat grafts in\nstem cells and 2) clinical outcome at 6 and 12 months.\nMethods: To evaluate the ability to enrich stem cells, we compared, for each patient (n = 20), the standard lipoaspirate\nwith the respective stem cell-enriched one, analyzing yield, immunophenotype and colony-forming capacity of the SVF\ncells as well as immunophenotype, clonogenicity and multipotency of the obtained adipose stem cells (ASCs). Regarding\nthe clinical outcome, we compared, by ultrasonography imaging, changes at 6 and 12 months in the subcutaneous\nthickness of patients treated with stem-cell enriched (n = 14) and standard lipoaspirates (n = 16).\nResults: Both methods relying on the enzymatic isolation of primitive cells led to significant increase in the frequency, in\nthe fat grafts, of SVF cells as well as of clonogenic and multipotent ASCs, while the enrichment was less prominent\nfor the device based on the mechanical isolation of the SVF. From a clinical point of view, patients treated with\nSVF-enhanced fat grafts demonstrated, at six months, a significant superior gain of thickness of both the central and\nsuperior-medial quadrants with respect to patients treated with standard lipotransfer. In the median-median quadrant the\neffect was still persistent at 12 months, confirming an advantage of lipotransfer technique in enriching improving\nlong-term fat grafts.\nConclusions: This comparative study, based on reproducible biological and clinical parameters and endpoints, showed\nan advantage of lipotransfer technique in enriching fat grafts in stem cells and in favoring, clinically, long-term fat grafts.
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