Why Breasts Are the Key to the Future of Regenerative Medicine

Friday, October 22nd, 2010

Implants have always struck me as a crude way to reshape the human body.  Now researchers are perfecting the use of stem cells for breast reconstruction and augmentation — with the promise that the same technology will eventually be applied to more vital body parts.

The American technology first found a home in Japan, for peculiarly Japanese reasons:

They found their humans in Japan, where the company had connections to surgeons through their business partners. But Japan made sense for another reason: There, the disfigurement of a mastectomy or lumpectomy is tantamount to social banishment. Much of a traditional woman’s social life centers on public baths, and those whose breast cancer has left them deformed seldom go. When Keizo Sugimachi, a surgeon and president of Kyushu Central Hospital in Fukuoka, learned what Cytori was developing, he launched an investigator-initiated (as opposed to Cytori-sponsored) trial, dubbed Restore 1. Over the course of six months in 2006, he treated 20 women who’d had a partial mastectomy two to five years before. It was also the first clinical use of Cytori’s Celution System. Hedrick assisted on nearly all of the procedures and helped orchestrate how each would progress.
They got better with each case, improving the protocol as they went. In December 2007, Sugimachi told the San Antonio Breast Cancer Symposium that all 20 of the women in Restore 1 tolerated the procedure just fine, none had an immune response, and 79 percent were satisfied with the outcome. There was no significant loss of breast size between one month and the final assessment 12 months later. That was a crucial barometer, given what happens when plastic surgeons inject fat alone, which was a popular cosmetic-surgery technique in the 1980s and 1990s: The injected fat tended to vanish into the surrounding tissue several weeks later like butter into the crannies of a hot English muffin. (Women who opted for this method were encouraged to think of breast enhancement like a dye job — once the effect fades, go back for another session.) But Cytori’s adipose stem cells stuck around.
Restore 1 showed that Cytori’s cells could rebuild breasts lost to cancer. The next logical step was trying it out for breast augmentation. Perhaps not surprisingly, once again this happened in Japan. The country has a strong and entrenched cultural prejudice against putting anything foreign into one’s body; organ transplants were slow to be adopted in Japan and still remain rare. But if that ick factor is the immovable object, the Western-inspired desire for bigger breasts is the irresistible force.

In late 2007, cosmetic surgeon Tatsuro Kamakura of Cosmetic Surgery Seishin in Japan began a study of the Celution System for breast augmentation, eventually enrolling 20 women. In 2008 he told the Congress of the Japan Society of Aesthetic Surgery that the first three patients kept their new volume and that the tissue remained soft and natural. He had injected an average of 160 cc of stem-cell-loaded fat droplets, boosting breast circumference an average of 4 centimeters (1.6 cup sizes). In commercial use, a new breast could run about $2,000 to $2,800, depending on physician charges. “It’s probably a $1 billion market,” Calhoun says. “You can buy an appliance with a 30 to 40 percent unpleasant rate or you can use your own cells. Which would you choose?”

But the possibilities aren’t boundless. “It’s not a substitute for implants for women who want to look, um, unnaturally large,” Hedrick says. “You can’t take a flat-chested woman and make her look like a dancer at a strip club. We’re not targeting that market. If they don’t care about looking natural, let them do silicone. The goal of this is a natural, soft-tissue feeling. Plus, there is a whole new market of women who would love another 100 to 200 cc but would never have an implant. I think that’s bigger than the current breast implant market” — a sea of women who wouldn’t consider a silicone implant but who would be intrigued by the opportunity to have their breasts plumped with cells from their own bodies while reducing the fat in their hips and abdomen to boot.

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