American Association of Plastic Surgeons

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Comparison Of Relative Aromatase Gene Expression In Lipoaspirate Extracted Using Active Filtration, Low Pressure Decantation, And Traditional Suction Decantation
Sophia Arbuiso, BS1, Ashley Zhang, BSE1, Isaiah J. Rhodes, MA1, Chase C. Alston, MHS1, David Janhofer, MD1, Yunchan Chen, BS1, Nicholas A. Vernice, MD1, Grant G. Black, BA1, Kristy A. Brown, PhD2, David M. Otterburn, MD1.
1Weill Cornell Medicine Department of Plastic Surgery, New York, NY, USA, 2Weill Cornell Medicine Department of Medicine, New York, NY, USA.

Introduction: Autologous fat transfer is used to optimize breast contour and improve deformities following post-mastectomy reconstruction. Adipose tissue extracted during the procedure comprises of adipocytes and a stromal vascular fraction consisting of adipose stromal cells (ASCs), endothelial cells and other immune-cell types. ASCs are the primary mediators of androgen to estrogen aromatization, which may be of concern for patients with a history of hormone receptor positive (HR+) breast cancer. It is documented in the literature that post-menopausal women and women with higher BMIs express higher levels of aromatase mRNA.5 Various methods of autologous fat transfer for harvesting the lipoaspirate are available for use. Given the relative paucity of biochemical data, this study aims to examine whether the method of fat processing influences the degree of aromatase gene expression in lipoaspirates, and the impact of menopausal status and BMI on gene expression.
Methods: A prospective, single center randomized control trial (ClinicalTrails.gov identifier: NCT04891510) enrolled patients aged >=18 with a history of complete or partial mastectomy undergoing reconstruction. Patients were randomized into one of three study arms distinguished by method of fat grafting (active filtration, low pressure decantation, and standard decantation) in a 1:1:1 ratio. qRT-PCR for aromatase (CYP19A1) was used to compare mRNA levels. Spearmanís rank correlation coefficient, Mann-Whitney U Test, Kruskal-Wallis test, and simple linear regression were used for analysis.
Results: In pooled analysis across all samples, aromatase mRNA levels are significantly correlated to BMI and menopausal status (p<0.05) in patient tissue. Subgroup analysis showed stronger positive correlation between aromatase mRNA and BMI for samples collected in traditional suction decantation (correlation p<0.05), and a stronger effect of menopausal status on aromatase gene expression in samples collected in low pressure decantation (p < 0.05).
Conclusion: The observed stronger correlation between BMI and menopausal status on aromatase mRNA levels in the tissue processed using the traditional and low-pressure decantation may point to the greater enrichment for stromal vascular component in the extracted lipoaspirates by these two techniques. Active filtration may remove more ASCs and allow for a higher fraction of adipocytes. Given the potential for lower retention of ASCs and therefore lower levels of aromatase expression in the lipoaspirate with the active filtration technique, active filtration may be the optimal technique for fat grafting in patients who have HR+ breast cancer, especially in breast conservation patients. While there is conflicting evidence on the pro-tumorigenic effects or influence of ASCs on dormant breast cancer cells, reduced chronic inflammation, which has been linked to lower aromatase/ASC levels, may offer longitudinal benefits for patients with a history of breast cancer.



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