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Autologous Fat Grafts: Can We Match the Donor Fat Site and the Host Environment for Better Postoperative Outcomes and Safety?

  • Plastic Surgery (D. Otterburn, Section Editor)
  • Published:
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Abstract

Purpose of Review

Autologous fat grafting is the gold standard for soft tissue repair. The donor fat depot is chosen where a surplus of subcutaneous fat is found. However, the adipose tissues from different parts of the body are not equivalent. Despite the heterogeneity in fat depots, it is still considered that any adipose tissue site is a suitable fat depot donor for transplantation.

Recent Findings

Matching embryonic origins and Hox code between transplanted stem cells and the host microenvironment emerges as a critical parameter to achieve correct repair in different preclinical models. It has also recently been reported that the individual fat depots routinely used in reconstructive surgery exhibit distinct embryonic origins and express different HOX code. An opposite gradient from the upper to the lower body exists between expressions of HOXC10 and the neural crest marker PAX3. This observation raises the question of the choice for the best fat donor site.

Summary

Matching between the host tissue and the donor fat sites is a factor that urgently deserves consideration to improve postoperative outcomes and safety of autologous fat grafting.

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References

Papers of particular interest, publishes recently, have been highlited as: Of importance •• Of major importance

  1. Coleman SR. Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg. 1995;19(5):421–5.

    Article  CAS  PubMed  Google Scholar 

  2. Kolle SF, Fischer-Nielsen A, Mathiasen AB, Elberg JJ, Oliveri RS, Glovinski PV, et al. Enrichment of autologous fat grafts with ex vivo expanded adipose tissue-derived stem cells for graft survival: A randomised placebo-controlled trial. Lancet. 2013;382(9898):1113–20.

    Article  PubMed  Google Scholar 

  3. Dykstra JA, Facile T, Patrick RJ, Francis KR, Milanovich S, Weimer JM et al. Concise review: Fat and furious: Harnessing the full potential of adipose-derived stromal vascular fraction. Stem Cells Transl Med. 2017;6(4):1096–108. The authors performed a review of the scientific and medical literatures on the regulatory issues, the current applications and the mechanisms of action of the SVF. They show the importance of paracrine effects of SVF and of the crosstalk between the SVF components and the host environment.

  4. Liao HT, Marra KG, Rubin JP. Application of platelet-rich plasma and platelet-rich fibrin in fat grafting: basic science and literature review. Tissue Eng Part B Rev. 2013;20(4):267–76.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ailhaud G. Adipose tissue as an endocrine organ. Int J Obes Relat Metab Disord. 2000;24(Suppl 2):S1–3.

    Article  CAS  PubMed  Google Scholar 

  6. Kouidhi M, Villageois P, Mounier CM, Menigot C, Rival Y, Piwnica D et al. Characterization of human knee and chin adipose-derived stromal cells. Stem Cells Int. 2015;2015:592090. The authors analysed the global gene expression profile of paired adipose tissues of the inner side of knees and the face. These fat depots are usually fat donor site and host fat site, respectively. Data revealed that PAX3, a marker of embryonic origin, and the HOX genes were among the most differentially expressed between the two sites. The consequences of the mismatch between the sites remain to be functionally investigated.

  7. Tchkonia T, Tchoukalova YD, Giorgadze N, Pirtskhalava T, Karagiannides I, Forse RA, et al. Abundance of two human preadipocyte subtypes with distinct capacities for replication, adipogenesis, and apoptosis varies among fat depots. Am J Physiol Endocrinol Metab. 2005;288(1):E267–77.

    Article  CAS  PubMed  Google Scholar 

  8. Tchkonia T, Lenburg M, Thomou T, Giorgadze N, Frampton G, Pirtskhalava T, et al. Identification of depot-specific human fat cell progenitors through distinct expression profiles and developmental gene patterns. Am J Physiol Endocrinol Metab. 2007;292(1):E298–307.

    Article  CAS  PubMed  Google Scholar 

  9. Enerback S. Human brown adipose tissue. Cell Metab. 2010;11(4):248–52.

    Article  PubMed  Google Scholar 

  10. Svensson PA, Lindberg K, Hoffmann JM, Taube M, Pereira MJ, Mohsen-Kanson T, et al. Characterization of brown adipose tissue in the human perirenal depot. Obesity (Silver Spring). 2014;22(8):1830–7.

    Article  CAS  PubMed  Google Scholar 

  11. Cypess AM, White AP, Vernochet C, Schulz TJ, Xue R, Sass CA, et al. Anatomical localization, gene expression profiling and functional characterization of adult human neck brown fat. Nat Med. 2013;19(5):635–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wu J, Bostrom P, Sparks LM, Ye L, Choi JH, Giang AH, et al. Beige adipocytes are a distinct type of thermogenic fat cell in mouse and human. Cell. 2012;150(2):366–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Pfeifer A, Hoffmann LS. Brown, beige, and white: the new color code of fat and its pharmacological implications. Annu Rev Pharmacol Toxicol. 2015;55:207–27.

    Article  CAS  PubMed  Google Scholar 

  14. Petrovic N, Walden TB, Shabalina IG, Timmons JA, Cannon B, Nedergaard J. Chronic peroxisome proliferator-activated receptor gamma (PPARgamma) activation of epididymally derived white adipocyte cultures reveals a population of thermogenically competent, UCP1-containing adipocytes molecularly distinct from classic brown adipocytes. J Biol Chem. 2010;285(10):7153–64.

    Article  CAS  PubMed  Google Scholar 

  15. Rohrich RJ, Sorokin ES, Brown SA. In search of improved fat transfer viability: a quantitative analysis of the role of centrifugation and harvest site. Plast Reconstr Surg. 2004;113(1):391–5 discussion 6-7.

    Article  PubMed  Google Scholar 

  16. Ullmann Y, Shoshani O, Fodor A, Ramon Y, Carmi N, Eldor L, et al. Searching for the favorable donor site for fat injection: in vivo study using the nude mice model. Dermatol Surg. 2005;31(10):1304–7.

    Article  CAS  PubMed  Google Scholar 

  17. Geissler PJ, Davis K, Roostaeian J, Unger J, Huang J, Rohrich RJ. Improving fat transfer viability: the role of aging, body mass index, and harvest site. Plast Reconstr Surg. 2014;134(2):227–32.

    Article  CAS  PubMed  Google Scholar 

  18. Padoin AV, Braga-Silva J, Martins P, Rezende K, Rezende AR, Grechi B, et al. Sources of processed lipoaspirate cells: Influence of donor site on cell concentration. Plast Reconstr Surg. 2008;122(2):614–8.

    Article  CAS  PubMed  Google Scholar 

  19. Leucht P, Kim JB, Amasha R, James AW, Girod S, Helms JA. Embryonic origin and Hox status determine progenitor cell fate during adult bone regeneration. Development. 2008;135(17):2845–54.

    Article  CAS  PubMed  Google Scholar 

  20. Creuzet S, Couly G, Vincent C, Le Douarin NM. Negative effect of Hox gene expression on the development of the neural crest-derived facial skeleton. Development. 2002;129(18):4301–13.

    CAS  PubMed  Google Scholar 

  21. White P, Thomas DW, Fong S, Stelnicki E, Meijlink F, Largman C, et al. Deletion of the homeobox gene PRX-2 affects fetal but not adult fibroblast wound healing responses. J Invest Dermatol. 2003;120(1):135–44.

    Article  CAS  PubMed  Google Scholar 

  22. Wang KC, Helms JA, Chang HY. Regeneration, repair and remembering identity: The three Rs of Hox gene expression. Trends Cell Biol. 2009;19(6):268–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. •• Sanchez-Gurmaches J, Hung CM, Guertin DA. Emerging complexities in adipocyte origins and identity. Trends Cell Biol. 2016;26(5):313–26. The authors performed a comprehensive review of the literature on the emerging picture showing the multiple embryonic origins of the fat depots in mice.

  24. Billon N, Dani C. Developmental origins of the adipocyte lineage: new insights from genetics and genomics studies. Stem Cell Rev. 2012;8(1):55–66.

    Article  CAS  PubMed  Google Scholar 

  25. Chon SH, Pappas A. Differentiation and characterization of human facial subcutaneous adipocytes. Adipocyte. 2015;4(1):13–21.

    Article  CAS  PubMed  Google Scholar 

  26. •• Foissac R, Villageois P, Chignon-Sicard B, Georgiou C, Camuzard O, Dani C. Homeotic and embryonic gene expression in breast adipose tissue and in adipose tissues used as donor sites in plastic surgery. Plast Reconstr Surg. 2017;139(3):685e–92e. The authors analyzed the feature of seven fat depots. They show a gradient of expression from the upper to the lower part of the body. The study highlights that the different fat depots used in reconstructive surgery have different HOX code and embryonic origin, giving the first reflection on the most appropriate donor site according to the host environment.

  27. Font-Burgada J, Sun B, Karin M. Obesity and cancer: The oil that feeds the flame. Cell Metab. 2016;23(1):48–62.

    Article  CAS  PubMed  Google Scholar 

  28. Gale KL, Rakha EA, Ball G, Tan VK, McCulley SJ, Macmillan RD. A case-controlled study of the oncologic safety of fat grafting. Plast Reconstr Surg. 2015;135(5):1263–75.

    Article  CAS  PubMed  Google Scholar 

  29. Petit JY, Maisonneuve P, Rotmensz N, Bertolini F, Clough KB, Sarfati I, et al. Safety of lipofilling in patients with breast cancer. Clin Plast Surg. 2015;42(3):339viii–44viii.

    Article  Google Scholar 

  30. Largo RD, Tchang LA, Mele V, Scherberich A, Harder Y, Wettstein R, et al. Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: A systematic review. J Plast Reconstr Aesthet Surg. 2014;67(4):437–48.

    Article  PubMed  Google Scholar 

  31. Zhao M, Sachs PC, Wang X, Dumur CI, Idowu MO, Robila V, et al. Mesenchymal stem cells in mammary adipose tissue stimulate progression of breast cancer resembling the basal-type. Cancer Biol Ther. 2012;13(9):782–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Rowan BG, Gimble JM, Sheng M, Anbalagan M, Jones RK, Frazier TP, et al. Human adipose tissue-derived stromal/stem cells promote migration and early metastasis of triple negative breast cancer xenografts. PLoS ONE. 2014;9(2):e89595.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Agha RA, Fowler AJ, Herlin C, Goodacre TE, Orgill DP. Use of autologous fat grafting for breast reconstruction: a systematic review with meta-analysis of oncological outcomes. J Plast Reconstr Aesthet Surg. 2015;68(2):143–61.

    Article  PubMed  Google Scholar 

  34. •• Bertolini F, Petit JY, Kolonin MG. Stem cells from adipose tissue and breast cancer: hype, risks and hope. Br J Cancer. 2015;112(3):419–23. The authors provided a short review on the potential risk using adipose tissue for breast reconstruction and breast cancer. They discussed about the current dilemma between proposing to patients breast reconstruction to improve their quality of life and the potential risk. They insist on the requirement of actions to address this issue.

  35. •• Hoy AJ, Balaban S, Saunders DN. Adipocyte-Tumor Cell Metabolic Crosstalk in Breast Cancer. Trends Mol Med. 2017;23(5):381–92. In this review, the authors report the recent observations illustrating the bidirectional cross-talk between adipocytes and breast cancer cells that support the progression of disease by enhancing the cancer cell proliferation, invasion and treatment resistance.

  36. Strong AL, Burow ME, Gimble JM, Bunnell BA. Concise review: the obesity cancer paradigm: Exploration of the interactions and crosstalk with adipose stem cells. Stem Cells. 2015;33(2):318–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Pathiraja TN, Nayak SR, Xi Y, Jiang S, Garee JP, Edwards DP, et al. Epigenetic reprogramming of HOXC10 in endocrine-resistant breast cancer. Sci Transl Med. 2014;6(229):229ra41.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

The authors of this review are supported by the Fondation ARC pour la Recherche sur le Cancer 2016.

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Correspondence to Christian Dani.

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The authors declare no conflicts of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical collection on Plastic Surgery.

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Dani, C., Foissac, R., Ladoux, A. et al. Autologous Fat Grafts: Can We Match the Donor Fat Site and the Host Environment for Better Postoperative Outcomes and Safety?. Curr Surg Rep 5, 14 (2017). https://doi.org/10.1007/s40137-017-0178-1

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  • DOI: https://doi.org/10.1007/s40137-017-0178-1

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