Neumodisección con CO2 para lipotransferencia en reconstrucción mamaria / Pneumodissection with CO2 for transfer fat in breast reconstruction

Introducción La incorporación de la transferencia grasa como método accesorio a la reconstrucción con implantes permite hoy mayor seguridad y estabilidad de resultado en el tiempo. Es por ello que la optimización en el tratamiento de la lodge de la mastectomía con CO2 y campana de succión externa cobra un valor agregado en el mejoramiento tegumentario para aumentar la distribución y volumen de cobertura. Objetivos El objetivo es la preparación con succión externa y disección con CO2 del lecho receptor para la realización de reconstrucción mamaria diferida en pacientes mastectomizadas con radioterapia postmastectomía mediante la utilización de lipotransferencia y material protésico. Material y método Abordamos un grupo de 12 pacientes consecutivos con radioterapia postmastectomía que presentaban falta de cobertura, retracción cutánea, irregularidad de superficie, con una media de 43 años de edad ­entre un rango de 28 a 59 años­. Todas habían finalizado su tratamiento radioterapéutico hacía 1 año. La serie tuvo un seguimiento de 7 meses desde el primer procedimiento de lipotransferencia. Resultados En la comparación con nuestra serie general de 80 lipotransferencias en pacientes con radioterapia (sin neumodisector), se evidenció un mejoramiento clínico significativo de la lodge, por el aumento en la distribución a diferentes profundidades de un mismo plano del autoinjerto graso, impactando en una mayor superficie de cobertura y cambios estructurales de la piel. El espesor de los colgajos de la mastectomía fue evaluado con ecografías seriadas y rnm en la misma zona pre y postinjerto. Conclusiones Es evidente el mejoramiento de los tejidos mediante la utilización de la succión externa y aumento del grosor del lecho receptor con insuflación de CO2, con el consiguiente aumento de espesor en la distribución de grasa, que predispone a un mejor grado de prendimiento del autoinjerto y cobertura, pudiendo estos ser expandibles e indicar una reconstrucción con menor grado de morbilidad y mejor aceptación por la paciente.

Introduction The incorporation of transfer fat as accessory method to the reconstruction with implants today enables greater security and stability of result in time, so that the optimization in the treatment of the lodge of mastectomy with CO2 and external suction bell takes on an added value in the integumentary improvement to increase the distribution and volume of coverage. Objectives The aim is the preparation with external suction and dissection with CO2 of the receiving bed to perform breast reconstruction deferred in patients mastectomized and post-mastectomy radiotherapy using lipotransference and prosthetic material. Materials and method We approach a group of 12 consecutive post-mastectomy radiotherapy patients presenting with lack of coverage, cutaneous retraction, irregularity of surface, with an average of 43 years old, ­among a range of 28 to 59 years­. All had finished her radiotherapy treatment for 1 year; series was followed for 7 months from the first procedur eof lipotransference. Results Compared with our overall series 80 lipotransferences in patients with radiotherapy (without neumodissector), there is a significant clinical improvement of the lodge, by the increase in the distribution at different depths of the same level of fatty autograft, impacting on a larger surface coverage and structural changes of the skin. The thickness of the flaps of the mastectomy were assessed with serial ultrasounds and mri in the same area pre and post graft. Conclusions It is obvious the improvement of tissues, using external suction and increase of the thickness of the receptor bed with CO2 insufflation, with the consequent increase in thickness in the distribution of fat, which predisposes to a better degree of catch of autograft and coverage, which can be expandaded and indicate a reconstruction with lower degree of morbidity and better acceptance by the patient.

Effect of TGF-ß1 Stimulation on the Secretome of Human Adipose-Derived Mesenchymal Stromal Cells.

Adipose tissue is an attractive source of mesenchymal stromal cells (MSCs) owing to the relative ease of obtaining large volumes with more MSC abundance compared with other sources. Increasing evidence supports the fact that trophic factors secreted by MSCs play a pivotal therapeutic role. Several strategies in regenerative medicine use MSCs, mainly exploiting their immunosuppressive effect and homing capacity to sites of damage. Transforming growth factor-ß1 (TGF-ß1) is a pleiotropic cytokine that, depending on the cell niche, can display either anti-inflammatory or proinflammatory effects. TGF-ß1 expression increases in various tissues with damage, especially when accompanied by inflammation. Thus, we analyzed the effect of TGF-ß1 on the secretion by adipose-derived mesenchymal stromal cells (ASCs) of a panel of 80 cytokines/chemokines using an antibody array. To avoid a possible effect of fetal bovine serum (FBS) on ASCs secretion, we performed our analysis by culturing cells in FBS-free conditions, only supplemented with 0.1% of bovine serum albumin. We report the cytokine profile secreted by ASCs. We also found that TGF-ß1 exposure modulates 8 chemokines and 18 cytokines, including TGF-ß1 and -ß2, and other important cytokines involved in immunosuppression, allergic responses, and bone resorption.