A revolutionary technique using stem-cell research could soon allow women to choose breast enhancements made of living tissue instead of silicone.
Scientists who have been able to grow human fat cells in the laboratory for the first time say the breakthrough means that patients could, in effect, grow their own implants.
The researchers also claim that, in the longer term, it may be possible to grow replacement organs for transplant surgery. The target patients are cancer sufferers and others who need reconstructive surgery.
But the man who is pioneering the new technique, Jeremy Mao, professor of tissue engineering at the University of Illinois in Chicago, acknowledges that there could also be a substantial cosmetic market.
Doubts persist about silicone or saline implants which, despite technical improvements, can rupture or leak.
About 15,000 women had cosmetic surgery in the UK last year, according to figures from the British Association of Aesthetic and Plastic Surgeons, up from 9,916 in 2003.
In the US, about 6.2 million people need plastic surgery for medical reasons, mostly following the removal of a tumour. As many again have plastic surgery for cosmetic reasons.
Professor Mao has developed a method of isolating the patient’s stem cells, culturing them into a fatty tissue mass, and then building it around a “scaffold” of the correct shape for breasts or lips.
Professor Mao said he first took adipose stem cells from a human donor and isolated the fat-generating cells. These were mixed with a chemical, hydrogel, “which can be moulded into any given shape or dimension”. Hydrogel is a lightweight material licensed for use in medicine.
“You mould them into the shape of the other normal breast or the missing portion of breast and instead of implanting silicone or saline structures, we would use the stem cell-derived adipose implant,” Professor Mao said.
The living tissue implants would not “wear out”. And because they are derived from the patient’s own stem cells, there would not be a problem of tissue rejection that can arise with tissue from a donor.
“The technique is also applicable for other soft tissue, including facial tissue such as the lips.” he said
“Patients will have a choice – a stem cell grown structure or an artificial implant.”
There are, however, a number of issues yet to be resolved. One is the question of how the mass of living cells can develop a blood supply to keep it alive once it is implanted.
Another is how to stop the cells from continuing to replicate once the operation is complete. In the long term, scientists hope that it will be possible to culture stem cells into complete organs, or parts of organs. This would allow transplants to take place without the problem of rejection by the patient’s body.
More than 100,000 UK women are estimated to have had implant surgery, although exact figures are difficult to pin down. Materials such as ivory and sponge were inserted to enhance shape and size in the 19th century, and by the 1940s breasts were being directly injected with paraffin and silicone derivatives.
Silicone gel implants were introduced in the early 1960s. Health fears circulated after a US study found that up to 70 per cent of silicone implants ruptured.
In 1998 in the UK, a Government review found no evidence that silicone presented any greater risk than other implants. Many women switched to versions using soya oil, discontinued in the UK in 1999 over leak worries, and saline.
There is growing unease on the part of the medical profession at the level of interest in plastic surgery, which has been partly fuelled by TV programmes such as Nip/Tuck.
The British Association of Plastic Surgeons has said that the public obsession is leading to inappropriate referrals and encouraging poorly qualified surgeons to get involved.