Rigshospitalet at the leading edge with reconstruction following cancer surgery

As the first in the world, researchers at Rigshospitalet have just been authorised to test a completely new technique for reconstruction of the breast following cancer surgery. The hope is that future patients can avoid today’s more invasive surgery, using tissue flaps or implants.

Each year, surgeons in Denmark operate on about 4,200 patients for breast cancer. Many of these patients subsequently need plastic and reconstructive surgery with the risk of side effects, such as large scars, uneven texture and colouring on the reconstructed breasts or capsule formation around implants.

Fat from the stomach
Therefore, some years ago plastic surgeons began to work with fat grafting, where fat is taken from the patient’s stomach, thighs or buttocks and then used as a filler by injecting it into the adipose tissue.

“Reconstruction with the patient’s own tissue gives a more natural look and the use of prosthesis, which have to be replaced at some stage, can be avoided. Unfortunately, the problem with fat grafting is that the majority of the tissue is perished. There is also a risk of developing connective tissue, which can form lumps or some other deformation”, said Professor Drzewiecki from Rigshospitalet’s Department of Plastic Surgery and Burns Treatment.

These problems are the reason that Professor Drzewiecki and his research team, consisting of Stig-Frederik Trojahn Kølle, Physician, and Jens Jørgen Elberg, Consultant Surgeon, have chosen another method to find out how the patient’s own stem cells can be used to make the patient’s own adipose tissue ‘survive’, while maintaining a consistency similar to a normal breast.

They are working in close cooperation with Anne Fischer-Nielsen, Consultant Surgeon, and Roberto Olivieri, Registrar, from the Stem Cell Section at the Blood Bank.

Funding from the Danish Cancer Society
The project, which just received almost DKK 1 mill. in funding from the Scientific Committee of the Danish Cancer Society, is so epoch-making that experts around the world are following trials with great interest.

The Scientific Committee has just authorised trials on humans. Twenty voluntary patients are taking part, and after the summer the first trials will begin.

Cultivation of stem cells
Stig-Frederik Trojahn Kølle, Clinical Assistant and Physician, will remove stem cells from the adipose tissue from the first two test subjects. These stem cells will be isolated and cultivated to a certain concentration in the special laboratory at the Blood Bank’s Stem Cell Section.

Then the stem cell concentration will be mixed with the patient’s adipose tissue, so that the stem cells can ensure new formation of blood supply in the adipose tissue, on the assumption that the adipose tissue will be able to “survive” and will be suited for injection as part of a subsequent breast reconstruction.

“The problem today is that it is not possible to transplant a large lump of fat without it perishing, as there is no blood supply. But preliminary trials with this stem-cell technique, already carried out on animals, have shown very promising results”, said Stig-Frederik Trojahn Kølle.

Great future prospects
“At first, we hope to be able to come up with results, which can help the many women who have undergone breast surgery to a life, where they do not have to battle with side effects, which may arise in connection with the common reconstruction methods”, said Professor Drzewiecki, and he adds:

“If our theories on exploiting stem cells in the adipose tissue hold water, applications are far-reaching for many other groups of cancer patients, where complicated, invasive surgery and radiotherapy can change the patients’ looks to such a degree that it reduces their quality of life.

For instance, the many types of radiotherapy for some types of head and neck cancer patients may result in a marred appearance such as hollow facial features. The hope is that this new method, with customised fat injections, can to some extent rebuild the patient’s ‘old’ facial features.