Aft Active Fat Transporter
Also known as: Autologous Fat Transfer (AFT), autologous lipotransfer, fat grafting, AFT Active Fat Transporter, Autologous Fat Transfer
Overview
Autologous Fat Transfer (AFT), also known as autologous lipotransfer or fat grafting, is a medical procedure that involves harvesting adipose tissue (fat) from one area of a patient's body and transplanting it to another site. This technique is primarily used for reconstructive and therapeutic purposes, leveraging the regenerative potential of adipose-derived stem cells (ADSCs) and the stromal vascular fraction (SVF) contained within the fat. AFT is a minimally invasive procedure that utilizes the patient's own tissue, thereby reducing the risk of immunological rejection. Its main applications include breast reconstruction following mastectomy, cosmetic enhancements, and the treatment of radiation-induced fibrosis (RIF). Research on AFT is moderately mature, with several randomized controlled trials (RCTs) and systematic reviews supporting its efficacy and safety, particularly in reconstructive surgery and fibrosis treatment.
Benefits
AFT offers significant benefits, particularly in reconstructive surgery and tissue repair. In breast reconstruction post-cancer surgery, AFT has been shown to significantly improve patients' quality of life (QoL) compared to implant-based reconstruction. One RCT reported statistically significant improvements in satisfaction with breast (+9.9 points, p=0.002), physical well-being of the chest (+7.6, p=0.007), and overall satisfaction with the outcome (+7.6, p=0.04) at 12 months post-operation. Importantly, AFT does not increase oncological risk in breast cancer patients, confirming its safety in this population. For radiation-induced fibrosis (RIF), AFT shows promise in reducing fibrosis and improving tissue quality, with both histological and clinical improvements observed in animal models and human studies. The benefits are clinically meaningful, with QoL improvements exceeding 5 points on relevant scales. These effects are typically observed within weeks to months, with QoL benefits sustained at 12 months.
How it works
The regenerative effects of Autologous Fat Transfer (AFT) are primarily mediated by the adipose-derived stem cells (ADSCs) and the stromal vascular fraction (SVF) present within the transplanted fat. These cellular components secrete various growth factors and cytokines, such as VEGF and TGF-β, which promote tissue repair, remodeling, and angiogenesis. AFT enhances local tissue vascularization, reduces inflammation, and improves the mechanical properties of damaged or irradiated tissues by modulating extracellular matrix remodeling. The procedure acts as a cellular transplant, providing a rich source of regenerative cells that interact with the recipient site to facilitate healing and regeneration. It is not an orally absorbed compound, so absorption and bioavailability in the traditional sense are not applicable.
Side effects
Autologous Fat Transfer (AFT) is generally considered safe with a low incidence of complications. The most common side effects, occurring in over 5% of patients, are minor procedural complications such as bruising, swelling, and fat necrosis, where some of the transferred fat cells do not survive. Less common side effects, affecting 1-5% of patients, include infection at the donor or recipient site and the formation of cysts. Rare but serious complications, occurring in less than 1% of cases, include fat embolism, though this is exceedingly rare. There are no known drug interactions associated with AFT. Contraindications for the procedure include active infection at either the donor or recipient site, and uncontrolled systemic illnesses. Current evidence supports the safety of AFT in breast cancer patients, with no increased oncological risk identified.
Dosage
The concept of a 'minimum effective dose' for Autologous Fat Transfer (AFT) is not standardized, as the volume of fat transferred varies significantly based on the specific indication and individual patient anatomy. For breast reconstruction, mean volumes around 300 mL have been reported as effective. There is no established maximum safe dose, as it is dependent on patient tolerance, the capacity of the recipient site, and the surgeon's judgment. Multiple sessions may be required to achieve optimal volume retention and desired aesthetic or therapeutic outcomes. Techniques such as microfat or nanofat grafting are often employed to optimize graft survival. Graft survival is influenced by the surgical technique, the quality of the harvested fat, and the vascularity of the recipient site. In some cases, AFT may be combined with cofactors like platelet-rich plasma (PRP) or specific ADSC subtypes to potentially enhance outcomes.
FAQs
Is AFT safe for cancer patients?
Yes, current randomized controlled trial evidence indicates that Autologous Fat Transfer (AFT) does not increase oncological risk in breast cancer patients.
How long until results are seen?
Quality of life improvements in breast reconstruction are typically noted at 12 months. Tissue remodeling and anti-fibrotic effects in fibrosis models are observed over weeks to months.
Is it a one-time procedure?
Often, multiple sessions of Autologous Fat Transfer (AFT) are required to achieve optimal volume retention and desired results, especially for larger volume augmentations.
Does it improve fibrosis?
Yes, evidence from animal and some human studies supports the anti-fibrotic effects of AFT, particularly in radiation-induced fibrosis, by improving tissue quality and reducing scar tissue.
Research Sources
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10810439/ – This systematic review and meta-analysis, including 25 in vivo studies, demonstrated that Autologous Fat Transfer (AFT) leads to histological and clinical improvements in radiation-induced fibrosis. The study highlighted the role of adipose-derived stem cells (ADSCs) and the potential for augmentation with platelet-rich plasma (PRP) in mediating these anti-fibrotic effects, with observational periods averaging around 76 days.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9979010/ – This randomized controlled trial by Krastev et al. (2024) compared AFT with implant-based reconstruction for breast cancer patients. It found significant improvements in quality of life scores (e.g., satisfaction with breast, physical well-being) at 12 months post-operation for AFT patients, with no increased oncological risk, supporting AFT as a safe and effective option.
- https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0292013 – This systematic review and meta-analysis confirmed the regenerative mechanisms of Autologous Fat Transfer (AFT) in fibrotic tissue. It emphasized the crucial role of adipose-derived stem cells (ADSCs) and their contribution to extracellular matrix remodeling, providing a methodologically sound analysis of AFT's therapeutic potential in fibrosis.
