Breast Reconstruction After Mastectomy

We want to give women worldwide access to better surgery techniques for breast reconstruction after mastectomy; so they can put cancer behind them and focus on the future not their bodies

Breast Reconstruction After Mastectomy

We want to give women worldwide access to better surgery techniques for breast reconstruction after mastectomy; so they can put cancer behind them and focus on the future not their bodies

The need

Breast cancer is the most common cancer affecting women and one in eight women will develop the disease in their life time
An estimated 50,000 women are diagnosed with breast cancer each year in the UK, while in the US, more than 230,000 women were diagnosed in 2015 alone.
78% of women will now survive breast cancer for 10 years or more (2010-11 figures for England and Wales)
Treatment includes lumpectomy or mastectomy surgery with adjuvant therapy such as chemotherapy and/or radiation.
Around 40% of breast cancer patients will have a mastectomy. There were 23,200 mastectomies carried out in England in 2011/12 (NHS). This figure is likely to grow as more women opt for preventative mastectomy following the identification of the BRAC genes.
40% of women suffer from depression post-mastectomy.

 

Current treatment options for breast reconstruction following a mastectomy

Current guidelines recommend that women should be offered the option of breast reconstruction after mastectomy– either immediately or at a later date. The reconstruction techniques available include:

  • Artificial implants
  • Artificial implant with a tissue transplant from the patient
  • Free fat transfer where fat is taken from another part of the body is used to rebuild the breast
  • Free flap transfer where tissue including skin, fat and blood vessels are transplanted from another part of the body to reconstruct the breast

However, for various reasons each of these breast reconstruction methods can be unreliable and unsatisfactory.  Artificial implants can be rejected; they don’t always look or feel natural and will also need replacing every five to ten years.

Free fat and free flap transfer methods create a more natural look and feel. However, procedures frequently fail when the transferred fat is reabsorbed into the body.  The tissue transferred in free flap surgery can also be reabsorbed and tissue rejection is a common risk.

As a result patients will require multiple operations which mean long stays in hospital adding to trauma and distress.

A poor surgical outcome is the main reason why fewer than 50% of women who have a mastectomy currently chose to undergo reconstructive surgery.

 

 

 

 

 

 

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Researching breast reconstruction after mastectomy

Billions of pounds have gone into breast cancer research and treatment, an investment which has radically improved the life expectancy for women with even the most advanced cancers. However, a longer life expectancy means that women who have undergone mastectomy will also live with the physical and mental scars for many years, scars which can easily affect self-esteem, confidence and quality of life.

For most women, breasts are a vital part of identity, yet very little research has gone into improving breast reconstruction after mastectomy.

At RAFT, we want to see the same dedication and resolve going into breast reconstruction research that there has been in fighting breast cancer itself.

 

A new approach to breast reconstruction after mastectomy

RAFT has already carried out some important research to improve the success of the Free flap transfer technique (click here to learn more)

However, RAFT is now working on a novel product which will provide mastectomy patients with a new option for their breast reconstruction, which will not involve the implantation of synthetic material and associated dis-benefits.

The product in development is 3D ‘scaffold’, built from natural proteins found in breast tissue. It will be used in conjunction with fat supplemented with stem cells to help rebuild the breast, and ensure that the fat will stay within the breast reconstruction site rather than dissipating throughout the body. As the breast tissue grows, the implant will be absorbed, leaving behind a natural breast, made with the patient’s own body tissue.

Continue reading to learn more about the science behind this pioneering new technique.

 

Using Stem Cells in a Biological Implant to Improve Free Fat Transfer Breast Reconstruction

Free fat transfer involves transplanting fat from the patient’s own body, usually the belly or thighs, and using this to create a natural looking and feeling breast. While this technique overcomes the problem of foreign body reaction and high infection rate associated with implants, it does have its own complications as up to 90% of transferred fat can be reabsorbed by the body.

Recent studies have shown that when purified adipose derived stem cells (ADSCs) are added to the fatty tissue, the success of the free fat graft is improved dramatically because it reduces the amount of fat that is absorbed by the body.

 

So what are purified ADSCs and why are they so important?

Stem cells have the remarkable ability to develop into many different types of cells within the body. There are two types of stem cells: embryonic (which are produced in the womb during the development of a foetus), and adult stem cells (which help to repair the body).

We are looking at using adult adipose stem cells – those that help store fat. Once these stem cells are harvested, they are then purified so that only fat creating stem cells remain and all other types of cells (for example skin cells) are removed.

 

 

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Reducing Fat Absorption in Breast Reconstruction after mastectomy

It has been shown that mixing ADSCs with the patient’s own fat can reduce the amount of fat reabsorbed into the patient’s body.  However, the technique is still in its infancy and more research is needed to improve the procedures used to identify, purify and transfer the ADSCs quickly and effectively.

RAFT’s research has been focused on:

New techniques that will allow large numbers of ADSCs to be harvested within a standard operation time and at a low cost, so they can be transferred immediately to rebuild the patient’s breast.

Benefits: This will mean fewer operations for patients, reducing the inconvenience, trauma and pain of multiple operations. For the hospital, it will reduce costs, both in terms of harvesting the ADSCs and in terms of the number of operations required.

The laboratory work for this area of RAFT’s research has been completed.

Methods to combine ADSCs with a pioneering new 3D biological scaffold.

Benefits: Using a scaffold will ensure that the stem cell supplemented fat will stay within the breast reconstruction site rather than dissipating throughout the body. This will help to increase the survival rate and function of the cells after transplant and improve the cosmetic result. Moreover, the biological scaffold is made from proteins which naturally occur in breast tissue and will therefore be metabolised by the body as the new breast tissue is formed.

An initial 18 prototypes (with different combinations of natural proteins found in breast tissue) have been subjected to rigorous testing, and a final prototype will be chosen for scaling up into an implant that will be tested in a pre-clinical model (subject to funding). RAFT researcher Dr Prasad Sawadkar (pictured below) is working closely with clinicians to develop an implant that not only improves the lives of patients, but also, more importantly, caters to the surgeons’ needs.

 

 

 

Research Impact 

RAFT’s research to improve breast reconstruction surgery will mean that women who have undergone mastectomy:

  • Experience less pain and discomfort
  • Need fewer operations
  • Experience less scarring and numbness
  • Have a better, more natural cosmetic result
  • Have a vastly reduced risk of tissue rejection
  • Experience reduced psychological impact

Ultimately, our research will mean that women can put the black cloud of breast cancer and its aftermath behind them and concentrate on rebuilding their lives.

 

RAFT Research Scientists:
  • Dr Prasad Sawadkar
  • Dr Stuart Brown
  • Dr Elena Garcia

     

Research Partner:
  • Professor J.C. Knowles, Head of Division of Biomaterials and Tissue Engineering, UCL
  • Dr Umber Cheema; Senior Lecturer, Division of Surgery and Interventional Science, UCL

     

 

 

 

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