Möglichkeiten und Grenzen der autologen Fetttransplantation – „Consensus Meeting” der DGPRÄC in Hannover, September 2009

Zusammenfassung

Nachdem die ersten Transplantationen von größeren Mengen an Eigenfett insbesondere in den USA von den Fachgesellschaften kritisch bewertet wurden, gewinnt die Transplantation von Fettgewebe nach Ihrer Erstbeschreibung vor mehr als 100 Jahren wieder an Bedeutung. In einer Konsensuskonferenz (Evidenzgrad V) der DGPRÄC anlässlich der Jahrestagung in Hannover wurde eine Bestandsaufnahme zu verschiedenen Aspekten der autologen Fett(zell)transplantation durchgeführt. Regulatorisch muss das Gewebegesetz eingehalten werden. Um Ergebnisse vergleichen zu können, ist es wichtig die Entnahme-, Verarbeitungs- und Reinjektionstechnik detailliert anzugeben. Es besteht Einigkeit, dass Fett mit geringem Sog gewonnen werden soll und in dünnen multiplen Schichten wieder eingebracht werden sollte (Evidenzgrad V). Die objektive Quantifizierung des Transplantationserfolges ist derzeit mit der MRT möglich und vielversprechend (Evidenzgrad III). Die knappe klinische Studienlage zu Indikationen und langfristigen Erfolgen der autologen Fetttransplantation geht über einen Evidenzgrad II nicht hinaus. Die Risiken der autologen Fetttransplantation sind bei korrekter Technik eher gering; eine Tumorinduktion durch die Transplantation von Fett-, Stroma- und Stammzellen aus abgesaugtem Fett erscheint derzeit unwahrscheinlich. Neue Techniken wie die Stamm- und Stromazell angereicherte Fetttransplantation eröffnen möglicherweise weitere Indikationen.

Abstract

One hundred years after the first description of autologous fat transplantation, this technique is receiving renewed attention. Initially, critically reviewed by plastic surgery societies, particularly those in the United States, the transfer of autologous fat was recently addressed at the September 2009 annual meeting of the German Society of Plastic Reconstructive and Aesthetic Surgeons in Hannover. In this consensus meeting, the panel reviewed both the current status of autologous fat transfer as well as established data concerning this evolving practice. In Germany, autologous fat transplantation is regulated by the Law on Tissue Transfer and Processing (Gewebegesetz). In an effort to facilitate future comparisons it is mandatory to describe harvesting, processing and reinjection techniques in detail. The consensus panel concluded that fat should be harvested using low vacuum settings and then transplanted in thin layers (Evidence V). Quantification of transplanted fat can best be performed by MRI (Evidence level III). Limited clinical studies are available with only some reaching a level of evidence II. At present, risk associated with autologous fat transplantation is considered to be minor. Tumor induction by autologous fat grafting is not proven. New techniques like stem cell enriched fat grafts may offer new promise for the Plastic and Reconstructive Surgeon.

Schlüsselwörter

Liposuction - Mammaaugmentation - Fettgewebe

Key words

breast augmentation - tissue engineering - fat tissue

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