Oncological outcomes of lipofilling breast reconstruction: 195 consecutive cases and literature review: Beyond the Abstract

During the last decade, fortunately women have increased their access to breast reconstruction after cancer surgery. Therewith, they are more informed and demand better aesthetic and functional results. Several techniques have been developed to achieve more natural and comfortable breast feeling.

Lipofilling has gained a crucial space as single or supplementary technique within this field. However, some concerns have been raised about the possible deleterious effect that might have cancer stem cells contained in fat grafting when brought into contact with a tumor bed. In vitro and animal studies have showed high angiogenic stem cells potential1, 2. Even in humans, this metabolically active tissue has proven its effectiveness for the treatment of skin disorders after radiotherapy3, 4. On the other hand, no prospective human trials are available that indicate an increased recurrence incidences in patients treated with lipofilling for breast reconstruction. Only 2 retrospective studies have described an increased risk of locoregional recurrence with fat grafting in patients with certain characteristics; one with 59 patients with intraepithelial carcinoma5 and another study with 434 patients who were under hormone treatment6. However, these data have not been replicated in other series7, 8

In the current study, we follow 195 consecutive breast cancer patients treated with 319 lipofilling procedures over a period of seven years. For the whole series we found 6 locoregional recurrences (1.08% per year), demonstrating our preliminary hypothesis, we found no difference in the rate of locoregional recurrence compared with previous series without use of lipofilling. At the moment there are no objectives data to transfer apprehension of laboratory studies to clinical practice.

Although in this study there was no significant difference, adding up to this review, recent unpublished work show us that probably with longer follow-up, we will find that lipofilling use in very early stages after cancer surgery, could increase the recurrence risk. A limitation of the current study is the lack of control group with similar characteristics to validate our data. We are currently designing a study that keeps bias under control, contrasting homogeneous groups to detect patient`s condition that could negatively influence the use of fat grafting.


Written by: Claudio Silva-Vergara1-2, Joan Fontdevila2, Omar Weshahy2

1 Universidad Autónoma de Barcelona, Department of Surgery, Spain.

2 Plastic and Reconstructive Surgery Department, Clínic Hospital of Barcelona, Spain.

References
1. Vona-Davis, L., Rose, D. P. Adipokines as endocrine, paracrine, and autocrine factors in breast cancer risk and progression. Endocr Relat Cancer 2007;14:189-206.

2. Zhang, Y., Daquinag, A., Traktuev, D. O., et al. White adipose tissue cells are recruited by experimental tumors and promote cancer progression in mouse models. Cancer Res 2009;69:5259-5266.

3. Coleman, S. R. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 2006;118:108S-120S.

4. Rigotti, G., Marchi, A., Stringhini, P., et al. Determining the oncological risk of autologous lipoaspirate grafting for post-mastectomy breast reconstruction. Aesthetic Plast Surg 2010;34:475-480.

5. Petit, J. Y., Rietjens, M., Botteri, E., et al. Evaluation of fat grafting safety in patients with intraepithelial neoplasia: a matched-cohort study. Ann Oncol 2013;24:1479-1484.

6. Kronowitz, S. J., Mandujano, C. C., Liu, J., et al. Lipofilling of the Breast Does Not Increase the Risk of Recurrence of Breast Cancer: A Matched Controlled Study. Plast Reconstr Surg 2016;137:385-393.

7. Delay, E., Garson, S., Tousson, G., Sinna, R. Fat injection to the breast: technique, results, and indications based on 880 procedures over 10 years. Aesthet Surg J 2009;29:360-376.

8. Gale, K. L., Rakha, E. A., Ball, G., Tan, V. K., McCulley, S. J., Macmillan, R. D. A case-controlled study of the oncologic safety of fat grafting. Plast Reconstr Surg 2015;135:1263-1275.

Read the abstract