The Impact of N-Acetylcysteine on Autologous Fat Graft: First-in-Human Pilot Study

Abstract

Background: Our goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability.

Methods: The study included 15 women with a mean age of 31.8 years (range 23-39 years) who underwent breast asymmetry correction with AFG harvested from both thighs. One thigh was infiltrated with a standard tumescent fluid (control graft) and other with a NAC-enriched tumescent fluid (NAC-treated graft). Each participant had breast MRI imaging before and 6 months after the procedure. Also, adipose tissue samples from each graft were subjected to biochemical analysis, flow cytometric assay and qRT-PCR to determine the markers of oxidative stress, angiogenesis and adipogenesis.

Results: Concentration and activity of superoxide dismutase in the NAC-treated grafts turned out to be significantly higher than in the control grafts, in both fresh (p = 0.041 and p = 0.023, respectively) and frozen samples (p = 0.004 and p = 0.003, respectively). The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). iNOS was the only qRT-PCR target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027). Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, although it was found to be statistically insignificant (p = 0.149). No postoperative complications were observed during a 6-month follow-up.

Conclusions: Some results of this study are promising. Further studies on larger groups are needed to determine NAC impact on AFG.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Trial registry name: The Impact of N-Acetylcysteine on Volumetric Retention of Autologous Fat Graft for Breast Asymmetry Correction.

Registration identification number: NCT03197103. URL FOR THE REGISTRY: https://ichgcp.net/clinical-trials-registry/NCT03197103?term=acetylcysteine&rank=6.

Keywords: Acetylcysteine; Autologous fat graft; Breast; Lipofilling; Oxidative stress.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2020. The Author(s).

Figures

Fig. 1

Autologous fat graft acquisition and usage framework. a Infiltration of each thigh with either Klein control tumescent solution or solution enriched with NAC. Using the suction-assisted liposuction technique, lipoaspirate from each thigh was collected to a separate canister. b After sedimentation and static decantation, a total of 65 ml of AFG was sent for biochemical, flow cytometric and genetic analyses. c A total of 145 ml of NAC-enriched AFG was implanted to one breast, while the same volume of the control AFG was injected to the other breast

Fig. 2

Intergroup differences in the concentrations and activity of SOD in fresh and frozen AFGs

Fig. 3

Intergroup differences in the levels of NO in fresh and frozen AFGs

Fig. 4

Intergroup differences in the levels of ROS in fresh and frozen AFGs

Fig. 5

Comparison of flow cytometry results

Fig. 6

Comparison of iNOS gene expressions

Fig. 7

Breast appearances after 6 months. No noticeable size difference can be observed