Exclusive Make Me Heal Interview With The Pioneer of Stem Cell Breast Augmentation

Breast Augmentation Photos Of Real Patients Coming Soon.

The future of natural breast enhancement without implants is here and this time it’s not bogus. Japanese scientists have pioneered a treatment that offers a natural breast augmentation that uses stem cells and fat derived from the patient’s own body to create soft and naturally augmented breasts. As no implants are needed and only self-extracted stem cells and fat are used, the patient’s enhanced breasts are essentially “real.”

One treatment can successfully increase breast volume by 120-160 ml (1 ml equals 1 cc), which is the rough equivalent of two bra-cup sizes (5 to 7 cm). For patients seeking to augment their breasts by 300 ml, the treatment needs to be performed twice. In both cases, no implant is used. For augmentations exceeding 300 ml, a combination of an implant and the stem cell technique is used to achieve the desired results.

Pioneered in Japan by plastic surgeon Dr. Kotaro Yoshimura, the Cell-Assisted Lipotransfer (CAL) soft tissue augmentation technique claims to result in breasts that look and feel more natural and smoother without implants and the larger scars that accompany traditional breast augmentations using implants. The technique is performed by suctioning fat from the abdomen or thigh and then injecting the fat together with adipose-derived stem cells obtained from the patient back into the breast. The liposuctioned fat mixture, which now contains a high level of stem cells, is then transplanted layer by layer back into each breast to ensure an even distribution of the fatty mixture. What then occurs is that the stem cells enable the fat to grow its own blood supply, which leads to the fat becoming a part of the breast as opposed to a foreign mass. Some of the cells produce more fat and other cells change into a living blood supply for new breast tissue that grows into the treated breast. Unlike traditional breast augmentations, there are no incisions involved, as only small needle punctures are made on each breast that lead to tiny imperceptible marks (a detailed description of the procedure follows the interview at the bottom). Furthermore, enhancing one’s breast through the stem cell technique eliminates the risks associated with implants including deflation and leakage, capsular contracture (hardness and deformity), autoimmune disease (neurological problems), infection (skin redness and fever), and displacement (asymmetry and dislocation). Because the patient uses one’s own stem cells and fat, the CAL technique carries no risk of the tissue being rejected by the body.

Beyond breast augmentation, the stem cell technique can also be used for breast reconstruction following breast cancer, facial wrinkle removal, buttock augmentation, and to repair facial disfigurements.

Dr. Yoshimura and his team have already treated 54 patients (for breasts and facial procedures) since beginning their clinical trials in 2003, and have had no major problems. With 39 stem-cell breast augmentations already performed, Dr. Yoshimura is confident that the technique will be widely adopted within the next 5 years. Already approved in the European Union and Britain, stem cell-assisted breast enhancement may soon become a reality in the United States.

The main drawback to the procedure is that breast volume can only increase 120-160 ml per treatment, with a maximum breast enlargement of 300 ml through two treatments. Additionally, very thin patients may lack an adequate supply of adipose fat.

Make Me Heal caught up with Dr. Yoshimura, who pioneered the use of stem cells in plastic surgery procedures. In this exclusive interview, Dr. Yoshimura explains the details of the procedure, its inherent advantages over traditional breast augmentations, as well as his vision for the Brave New World of plastic surgery.

MMH: What is the stem cell-assisted treatment for breast augmentation that was developed by the Department of Plastic Surgery at the University of Tokyo? How is it unique?

Dr. Yoshimura: Yes. It is unique because it supportively uses adipose-derived stem cells to boost the efficacy of lipoinjection. Adipose-derived stem cells (ASCs) are isolated from liposuction aspirates and are then added to another aspirated fat and then injected to the breasts and so on. Aspirated fat, graft material, is originally stem cell-poor, but it is turned into stem cell-rich fat, which survives better and avoids post-operative atrophy. We call this treatment “Cell-Assisted Lipotransfer (CAL)”.

MMH: What are the main cosmetic and health advantages of a stem cell-assisted breast augmentation compared to silicone or saline implants?

Dr. Yoshimura: Now 99% of patients of breast augmentations (annually 250,000 in US, 1 mil in the world) are being performed with artificial implants. But 50,000 patients remove their implants every year in the US due to complications (capsular contracture, dislocation, hardness, round shape, unnaturalness, etc.). Thus, lots of patients suffer from complications derived from artificial implants. In addition, lots of patients are concerned about their “fake” breasts and having a mental stress in daily life. Some did not inform their husbands or boyfriends and are living with a sort of fear that it may be known by them some day in the future, e.g when taking an X-ray. New substitutes must be welcomed.

Our method can provide soft and natural breasts and they are “real” breasts. With aging, the real breasts can age as well as normal ones.

MMH: For a breast augmentation, does your procedure use any implant at all? If yes, what kind of implant?

Dr. Yoshimura: No other implants. Only patients’ own tissue.

MMH: Are there any size limitations as far as breast size for a woman having a stem cell-assisted breast augmentation? Can any breast size be accommodated in such a treatment?

Dr. Yoshimura: A limitation of the CAL method is augmentation volume. We can enlarge a breast by 120-160 ml [1 ml is equivalent to 1 cc] in a CAL surgery. If she wants a 300 ml gain, she needs the surgery twice. If silicon implants are used, she can get 300ml or more. In addition, lean patients have limited adipose.

MMH: The literature suggests that the stem cell treatment you developed can be applied to various cosmetic surgeries. What cosmetic surgeries besides breast augmentation is (i.e. breast augmentation, liposuction, buttock augmentation, facial implants) is your stem cell treatment currently being used for?

Dr. Yoshimura: Soft tissue augmentation is for breasts, face, and hip (etc.). The reasons are 1) cosmetic (90%), 2) reconstructive (10%). Reconstructive ones are for inborn defects or acquired ones. The latter is composed of tissue defects after cancer resection surgery and after injuries such as traffic accidents.

MMH: How many patients have had the stem-cell assisted breast augmentation in the world? Can you provide photos of their results? If yes, please email them to us or provide us links to a website where we can get them.

Dr. Yoshimura: We have done Cell-Assisted Lipotransfer for 54 patients (mainly for breasts, 11 for face and 1 of the 11 is hip too) so far, and are going to add about 10 patients this month. We started this trial in 2003, and four years have passed with no major problems.

Currently, the CAL is available only at the Cellport Clinic Yokohama, Yokohama City, Japan. You can also see the website of Cellport Clinic Yokohama (www.cellport.jp/english), which was established specifically for this treatment last summer. You can see some before/after photos on the web site. The clinic is managed by a private company, Biomaster, Inc., which we have been collaborating with since 2002. No major problem is seen so far. Patients are generally satisfied with the results.

MMH: Please describe how a stem-cell assisted breast augmentation is performed as far as number of incisions or needle punctures, anesthesia, and other technical details. How are the stem cells extracted from the body? Are the stem cells extracted the same day that the cosmetic procedure is done? How long does the complete procedure last?

Dr. Yoshimura: No incisions. Four needle punctures on each breast. General anesthesia. We use our original devices for preparation of adipose to be injected, and for injection.

MMH: Can stem cells be taken from other areas of the body besides the thighs and the stomach to conduct the treatment?

Dr. Yoshimura: Yes, any other parts are fine, but we need sufficient volume of adipose (1,500 ml).

MMH: Do breasts of a stem-cell assisted breast augmentation look and feel more real to the touch compared to silicone or saline implants?

Dr. Yoshimura: Absolutely! I hope you touch them to recognize how natural they are.

MMH: Does the recovery process differ from a regular breast augmentation procedure? What symptoms can a patient expect to have (i.e. bruising, swelling, numbness) and for how long do they persist? Is there any period of time the patient should expect to be resting and not be active or at work?

Dr. Yoshimura: Generally similar, but the difference is our patient undergo liposuction too. So, patients have some bruising and swelling at thighs or stomach. I recommend them not to be active for 3 days and take 7 days off.

MMH: What are the main risks behind the procedure and why are some physicians having concern about using stem cells in cosmetic surgery procedures?

Dr. Yoshimura: For stem cells, some are concerned about unexpected behaviors such as malignant changes. But it is a story of embryonic stem cells or other manipulated stem cells. We use freshly-isolated, autologous, minimally manipulated (non-cultured) cells for homologous use.

MMH: Do stem-cell assisted implants have the same risk of rupture as saline or silicone implants? What happens if a stem-cell assisted implant ruptures? Are there any dangers due to rupture and what is the procedure to extract the implant?

Dr. Yoshimura: No, transplanted fat will not rupture unless it was transplanted as a big lump and formed a cyst as done before by many doctors. With a correct method, transplanted fat survives just like normal fat and never rupture. You can just imagine that fat tissue gets thick, and that’s it.

MMH: What is the cost of this procedure in Japan (in US$)?

Dr. Yoshimura: 25,000 USD. (including pre-examinations, operation, hospital charges, and periodic medical examinations after surgery)

MMH: Do you think this procedure may be approved in the United States? When?

Dr. Yoshimura: Yes, maybe next year.

MMH: Is the procedure approved anywhere outside of Japan?

Dr. Yoshimura: Not yet, but Cellport Clinic Seoul will be open in the 2nd half of this year in South Korea.

MMH: Are there other universities or medical centers taking interest on this procedure?

Dr. Yoshimura: I guess so, but I do not know in particular.

MMH: How do you envision the future of cosmetic surgery with the advancement of research on stem cells? Do you think stem cells can replace the use of implants completely for all areas of the body? Do you think stem cells can be used instead of dermal fillers (i.e. BOTOX, Restylane) to reduce fine lines? Do you see any application for stem cells in liposuction, face lift, and tummy tuck?

Dr. Yoshimura: Hair regrowth may be available some day in the future. This is our 2nd project on stem cells.

Stem cells are not good for dermal fillers. Extracellular matrix such as collagen or hyaluronic acids is much better for that purpose.

MMH: How long do the results of the stem cell-assisted breast augmentation treatment last? Does a stem cell-assisted breast augmentation last longer than a traditional breast augmentation? What can a patient expect 4-5 years and then 10 years after the treatment?

Dr. Yoshimura: Supposed to be permanent. The adipose tissue can turn over just as normal adipose. Patients can expect just aging after 10 years.

The following are the steps of a surgical procedure based on cell assisted lipotransfer (CAL):

Surgery performed using the CAL soft tissue augmentation procedure begins with general anesthesia, followed by liposuction, cell treatment, and lipoinjection.

Anesthesia

The patient is put under general anesthesia and does not feel pain. A saline solution containing a weak local anesthetic and a vasoconstrictor is injected into the areas where fat is to be suctioned. This procedure softens the treated area. Also, by constricting the blood vessels, bleeding is kept to a minimum.

Liposuction

Through a tiny incision in the skin, a narrow metallic tube is inserted and a liposuction pump is used to suction subcutaneous fat.

Breast Augmentation, Breast Reconstruction (both sides), Buttock Lift (about 45 min)
Breast Reconstruction (one side), Facial (about 25 min)

Cell Treatment

Stem cells are obtained from parts of the aspirated fat and mixed with the fat to be re-injected. Duration: About 90 min.

Lipoinjection

The fat mixed with stem cells is transplanted by a special injector for lipo-transplantation, little by little over a wide area in order to prevent it from becoming a lump.
Breast Augmentation, Breast Reconstruction (both sides), Buttock Lift (about 60 min)
Breast Reconstruction (one side), Facial (about 30 min)

After Surgery

The needle puncture on the skin from the lipoinjection may appear red after the surgery, although it will gradually disappear within one to two months.

Mild swelling occurs on the suctioned area or the injected area, although it will dissolve on its own within one month. Pain that is felt when the treated area is touched will disappear within two to four weeks.

A burning sensation may be experienced around the suctioned area, although it will disappear within a month.

Parts of the injected fat are gradually absorbed into the surrounding tissue, and the absorption will stabilize within three months.

Postoperative Requests

Overnight Hospital Stay

Since the treated area may swell and subcutaneous bleeding may occur after the surgery, we recommend that the patient stay in the hospital for one night. It is best if the patient is accompanied by someone upon release from the hospital.

Postoperative regular as an outpatient

A medical examination of the treated area will be scheduled for the following months after having surgery: 1, 2, 3, 6, 9, 12, 18, and 24. Other examinations (ultrasonography, MRI, and X-ray) will be scheduled on an ongoing basis. In order to maintain the best health, we urge the patient to schedule as many examinations as possible.

Dr. Kotaro Yoshimura is an Assistant Professor at the Department of Plastic Surgery in the University of Tokyo. He graduated from the University of Tokyo School of Medicine in 1985, and entered the Department of Plastic Surgery, University of Tokyo. From 1990 to 1998 he was an Associate doctor in the Department of Plastic Surgery at the University of Tokyo and during the years of 1994-1995 he was a visiting researcher at the Department of Plastic Surgery in the University of Michigan. Dr. Yoshimura is a member of the board of Japanese Society of Plastic & Reconstructive Surgery (JSPRS) and a Corresponding Member of American Society of Plastic Surgery (ASPS). (ASPS member#: 31317).

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