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Senologie - Zeitschrift für Mammadiagnostik und -therapie 2012; 9(1): 31-40
DOI: 10.1055/s-0031-1283977
Wissenschaftliche Arbeit
© Georg Thieme Verlag KG Stuttgart · New York

Autologe Fetttransplantation der Brust – Wo stehen wir heute?

Autologous Fat Transfer to the Breast – A Standard Procedure?
U. von Fritschen
1   Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Helios-Klinikum Emil von Behring, Berlin
,
A. Kleinschmidt
1   Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Helios-Klinikum Emil von Behring, Berlin
› Author Affiliations
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Publication History

Publication Date:
12 April 2012 (online)

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Zusammenfassung

Die Transplantation von autologem Fettgewebe in die weibliche Brust löst seit ihrer Erstbeschreibung Kontroversen aus. Anfänglich stand die mögliche Morbidität bzw. Einschränkung der onkologischen Diagnostik durch Kalzifikationen oder Zysten im Vordergrund. Seitdem zunehmend auch ein Einsatz zur Korrektur von Volumendefiziten nach brusterhaltender Therapie oder Rekonstruktion eines Mammakarzinoms erfolgt, rücken Fragen der onkologischen Sicherheit in den Vordergrund. Besonders die zusätzliche Anreicherung von Stammzellen wirft hierbei zahlreiche Fragen auf. Hinzu kommt, dass das technische Vorgehen in praktisch keinem Teilschritt abschließend evaluiert und standardisiert ist.

Dennoch handelt es sich nach den bisher vorliegenden Erfahrungen um eine vielversprechende Technik mit geringer Komplikationsrate und großem Potenzial für die Korrektur kleinerer Volumendefizite oder Strahlenfolgen. Für die Applikation in potenziellem Risikogewebe nach Mammakarzinom sind noch viele Fragen ungeklärt. Die Rolle von angereicherten Stammzellen ist noch weitgehend ungeklärt. Ihr Einsatz ist daher nur in kontrollierten Studien sinnvoll.

Für eine abschließende Bewertung der Eigenfetttransplantation reichen die bisherigen Erfahrungen nicht aus. Der Einsatz sollte daher zurückhaltend, bei selektieren Patientinnen und in einem Umfeld erfolgen, das eine engmaschige, strukturierte Nachsorge ermöglicht.

Abstract

Autologous fat transplantation has shown to be reliable and safe in correcting volume deficits in almost all areas of the body. Recently, there has been an increasing interest in the use of fatty tissue to fill defects resulting from breast conserving surgery and asymmetries after reconstructive breast surgery.

However, injection of fat into a previous tumor site may create a new environment for cancer and adjacent cells. Especially the application of enriched stem cell suspension rise many questions. Also virtually every step of the process remains to be evaluated and standardized. We describe and discuss the technique and highlight possible areas of concern.

Even though many questions remain to be answered the technique has shown a low complication rate so far and seems a versatile tool in plastic surgery to reconstruct volume deficits and post radiation sequela. The benefit and oncologic safety of stem cells enrichment remains to be proved and should therefore only be used in controlled trials.

For a final validation of autologous fat transplantation the current data is not sufficient. Until then, lipofilling should be performed in well selected patients, experienced hands, and a cautious oncologic follow-up protocol is advised.

Schlüsselwörter

Lipofilling - autologe Fetttransplantation - Brust

Key words

adipose tissue - autologous transplantation - fat transfer - breast surgery - lipomodelling
 

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