Discussion: Mechanical Signals Induce Dedifferentiation of Mature Adipocytes and Increase the Retention Rate of Fat Grafts.

Abstract

www.PRSJournal.com 1336 M and colleagues should be commended for this novel study on the effects of donor-site tissue preexpansion on fat grafting. Their study suggests that mechanical stretch induces mature adipocytes to dedifferentiate; this dedifferentiated fat has increased regenerative properties, making it ideal for fat grafting.1 The authors found a moderate but statistically significant increase in graft volume retention in the preexpanded group compared with the control group (56 percent versus 32 percent). This is an important proof of concept, but the ultimate use of this technology might not be in volume augmentation, as the authors suggest. In most clinical situations, patients would not accept the morbidity and inconvenience associated with implanting and explanting an internal expander into a donor site for a moderate improvement in final graft volume. Moreover, large-volume fat grafting is already routinely performed safely and effectively without the use of internal expanders.2 Using the principles established by basic scientists, surgeons have developed techniques to solve the problem of fat graft volume retention. Surgeons and scientists must now collaborate to solve much more complex problems in this field. Dedifferentiated fat has exhibited adipogenic, osteogenic, chondrogenic, angiogenic, myogenic, and neurogenic potential in the laboratory.3–5 Regulatory and scaling burdens associated with obtaining sufficient autologous dedifferentiated fat have stalled the clinical translation of this regenerative potential. The finding that a homogenous and functional source of dedifferentiated fat can be obtained by simply applying mechanical stretch could have a far-reaching impact on tissue engineering. As they continue to enhance our understanding and push the frontiers, we encourage the authors and other scientists to shift their focus away from the volume augmentation uses of adipose tissue and toward the other much needed regenerative capabilities.