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

• Published in: Aesthetic plastic surgery 2021-10, Vol.45 (5), p.2397-2405
• Main Authors: Pietruski, Piotr, Paskal, Wiktor, Paluch, Łukasz, Paskal, Adriana M., Nitek, Żaneta, Włodarski, Paweł, Walecki, Jerzy, Noszczyk, Bartłomiej
• Format: Article
• Language: English
• Subjects: Acetylcysteine - pharmacology; Adipose Tissue; Adult; Asymmetry; Breasts; Female; Humans; Mammaplasty; Medicine; Medicine & Public Health; NCT; NCT03197103; Original; Original Article; Otorhinolaryngology; Oxidative stress; Pilot Projects; Plastic Surgery; Retention; Retrospective Studies; Surgery; Transplantation, Autologous; Treatment Outcome; Volumetric analysis; Wound healing; Young Adult
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-020-01633-1

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://clinicaltrials.gov/ct2/show/NCT03197103?term=acetylcysteine&rank=6