BlueCross BlueShield of Tennessee Medical Policy Manual

Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast

DESCRIPTION

Autologous fat grafting to the breast has been used as an adjunct to reconstructive breast surgery to contour deformities and improve shape and volume.  Adipose-derived stem cells (ADSC) have been proposed as a supplement to the fat graft in an attempt to improve graft survival.

Although adipose-derived stem cells could play a role in graft survival through adipogenesis, a complete understanding of the mechanisms of interactions among adipose stem cells and growth factors is lacking. Questions related to isolation, harvesting and purification of adipose-derived stem cells, their effect on cancer cell growth and their long term efficacy remain.

POLICY

See also:

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

The evidence for the use of adipose-derived stem cells in individuals who have breast cancer and are undergoing autologous fat grafting to the breast includes small single-arm studies, some of which are prospective.  Limitations of the data are small numbers of participants, short-term follow-up and lack of understanding of the possible oncologic influence adipose-derived stem cells may have on the fat grafting procedure.  The evidence is insufficient to determine the effects of this technology on health outcomes.

SOURCES

American Society for Aesthetic Plastic Surgery/American Society of Plastic Surgeons. (2011). Joint ASPS & ASAPS Position Statement: Stem Cells and Fat Grafting. Retrieved January 11, 2017 from www.plasticsurgery.org.

BlueCross BlueShield Association. Medical Policy Reference Manual. (9:2017). Adipose-derived stem cells in autologous fat grafting to the breast. (7.01.153). Retrieved November 21, 2017 from BlueWeb. (7 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. NCD for breast reconstruction following mastectomy (140.2). Retrieved January 21, 2016 from https://www.cms.gov.

Charvet, H., Orbay, H., Wong, M. & Sahar, D. (2015). The oncologic safety of breast fat grafting and contradictions between basic science and clinical studies: a systematic review of the recent literature. Annals of Plastic Surgery,75 (4), 471-479. Abstract retrieved January 11, 2017 from PubMed database.

Kamat, P., Schweizer, R., Kaenel, P., Salemi, S., Calcagni, M., Giovanoli, P.,et al. (2015). Human adipose-derived mesenchymal stromal cells may promote breast cancer progression and metastatic spread. Plastic and Reconstructive Surgery, 136 (1), 76-84. Abstract retrieved January 8, 2016 from PubMed database.

National Institute for Health and Care Excellence. (2012). Breast reconstruction using lipomodelling after breast cancer treatment. Retrieved January 11, 2017 from www.nice.org.uk/guidance/ipg417.

Simonacci, F., Bertozzi, N., Grieco, M., Grignaffini, E. & Raposio, E. (2016) Autologous fat transplantation for breast reconstruction: A literature review. Annals of Medicine and Surgery. 12 (2016), 94-100. (Level 2 evidence)

Toyserkani, N., Jørgensen, M., Tabatabaeifar, S., Jensen, C., Sheikh, S., & Sørensen, J. (2017). Concise review: a safety assessment of adipose-derived cell therapy in clinical trials: a systematic review of reported adverse events. Stem Cells Translational Medicine, 6 (9), 1786-1794. Abstract retrieved November 22, 2017 from PubMed database.

U. S. Food and Drug Administration. (2006). Center for Devices and Radiological Health. 510(k) Premarket Notification Database.  K060482. Retrieved September 5, 2014 from http://www.accessdata.fda.gov.

Waked, K., Colle, J., Doornaert, M., Cocquyt, V., & Blondeel, P. (2017). Systematic review: the oncologic safety of adipose fat transfer after breast cancer surgery. Breast, 31. 128-136. Abstract retrieved November 22, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  1/10/2015

MOST RECENT REVIEW DATE:  12/14/2017

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