Regenerative Therapieansätze im Bereich der Mammachirurgie

Zusammenfassung

Neben den etablierten Techniken der gestielten und freien Gewebetransplantation zur Brustrekonstruktion werden als regenerative Therapieansätze das „Adipose Tissue Engineering“ und die autologe Fettgewebstransplantation „Structural Fat Grafting“ verfolgt. Während die Anfangseuphorie des Adipose Tissue Engineering in absehbarer Zeit erfolgreich Zell-Matrixkon­strukte ausreichender Größe, Funktionalität und langfristiger Volumenstabilität beim Menschen einzusetzen etwas geschwunden ist, erfährt das Fat Grafting seit einigen Jahren eine Renaissance. Einer der entscheidenden Faktoren für das „Engraftment“ der durch Tissue Engineering generierten Gewebekonstruktes ist die Ausbildung eines suffizienten Gefäßnetzes. Verbesserungen der Matrizes, die idealer Weise das natürliche Gewebe nachahmen sollten, wie die Verwendung von dezellularisiertem Fettgewebe und der Einsatz von undifferenzierten Zellen, wie die Adipose-derived Stem Cells (ASCs), welche sowohl zur Adipogenese und Neoangiogenese beitragen können, stellt einen vielversprechend neuen Ansatz dar. Beim autologen Fat Grafting wird durch das Gemisch aus Adipozyten und Zellen der stromal-vaskulären Fraktion (SVF) das Prinzip ein induktives „Microenvironment“ zu erzeugen, bereits im klinischen Alltag erfolgreich angewandt. Aufgrund der experimentellen Daten, die eine Interaktion der Adipozyten, ASCs und anderer Progenitorzellen mit Brustkarzinomzellen zeigen und der unzureichenden klinischen Datenlage zur onkologischen Sicherheit, sollte dieses Verfahren allerdings kritisch angewandt werden. Erst nach vorliegen guter klinischer Langzeitstudien wird ein abschließendes Statement möglich sein.

Abstract

Besides the established techniques of pediculed and free tissue transplantations for breast reconstruction, adipose tissue engineering and structural fat grafting are being applied as options for regenerative therapy. While the initial euphoria about the foreseeable realisation of cell-matrix entities of sufficient size, functionality and long-term volume stability for use in humans has diminished somewhat, fat grafting as experienced a renaissance in recent years. One of the decisive factors for the engraftment of the tissue graft generated though tissue engineering is the formation of an adequate vascular network. Improvements of the matrix, which ideally should mimic natural tissue, such as the use of adipose-derived stem cells (ASCs) that can contribute both to adipogenesis and neoangiogenesis represent promising new approaches. In autologous fat grafting, the mixing of adipocytes and cells of the stromal-vascular fraction (SVF) in order to generate the principle of an inductive microenvironment has already been applied successfully in clinical routine. On the basis of the experimental data that demonstrate an interaction of the adipocytes, ASCs and other progenitor cells with breast cancer cells and the insufficient clinical data regarding oncological safety, this procedure should only be used critically. A concluding evaluation will only be possible after long-term clinical studies have provided good results.

Schlüsselwörter

Mammarekonstruktion - Transplantation ­experimentell

Key words

breast reconstruction - tissue engineering - liposuction - experimental ­transplantations

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