Cell-Assisted Lipotransfer (CAL) and Stromal Vascular Fraction (SVF) in Combination with Autologous Breast Reconstruction: A Preliminary Feasibility Case Series.

BACKGROUND

Cell-assisted lipotransfer (CAL) with stromal vascular fraction (SVF) enrichment has gained increasing interest as a regenerative adjunct in breast reconstruction. However, standardized reporting of volumetric outcomes and reproducibility data remains limited. This study reports our preliminary feasibility experience integrating CAL/SVF into autologous and hybrid breast reconstruction with MRI-based volumetric assessment.

METHODS

Six patients undergoing breast reconstruction with CAL/SVF enrichment were prospectively evaluated. Reconstructive modalities included TRAM flap, latissimus dorsi flap, implant-based, and hybrid techniques. Intraoperative SVF isolation was performed using enzymatic digestion (0.075% type I collagenase, 30-40 minutes at 37 °C) followed by centrifugation and admixture with purified fat. Fat graft survival was assessed at 12 months using 3.0-Tesla MRI volumetry with VOI freehand segmentation. Interobserver reliability was evaluated using intraclass correlation coefficient (ICC).

RESULTS

Twelve-month fat retention ranged from 76.4% to 84.0%. No major complications occurred; one minor fat necrosis resolved without intervention. Descriptively lower retention values were observed in previously irradiated breasts. Interobserver agreement for MRI volumetry was excellent (ICC[1, 2] = 0.995; 95% CI, 0.975-0.996), supporting reproducibility of segmentation.

CONCLUSIONS

CAL/SVF integration in breast reconstruction demonstrated favorable intermediate-term volumetric retention and safety within this small feasibility cohort. MRI-based volumetric analysis showed excellent interobserver reliability. Given the limited sample size and cohort heterogeneity, findings should be interpreted as preliminary and hypothesis-generating. Larger studies with extended follow-up are warranted to validate long-term durability and the impact of prior radiation.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .