Lipofilling of the Breast Does Not Increase the Risk of Recurrence of Breast Cancer

A Matched Controlled Study

Steven J. Kronowitz, M.D.; Cosman Camilo; Mandujano, M.D.; Jun Liu, M.D., Ph.D.; Henry M. Kuerer, M.D., Ph.D.; Benjamin Smith, M.D.; Patrick Garvey, M.D.; Reshma Jagsi, M.D.; Limin Hsu, M.A.; Summer Hanson, M.D.; Vicente Valero, M.D.

Disclosures

Plast Reconstr Surg. 2016;137(2):385-393. 

In This Article

Abstract and Introduction

Abstract

Background: Although many plastic surgeons perform autologous fat grafting (lipofilling) for breast reconstruction after oncologic surgery, it has not been established whether postoncologic lipofilling increases the risk of breast cancer recurrence. The authors assessed the risk of locoregional and systemic recurrence in patients who underwent lipofilling for breast reconstruction.

Methods: The authors identified all patients who underwent segmental or total mastectomy for breast cancer (719 breasts) (i.e., cases) or breast cancer risk reduction or benign disease (305 cancer-free breasts) followed by breast reconstruction with lipofilling as an adjunct or primary procedure between June of 1981 and February of 2014. They also then identified matched patients with breast cancer treated with segmental or total mastectomy followed by reconstruction without lipofilling (670 breasts) (i.e., controls). The probability of locoregional recurrence was estimated by the Kaplan-Meier method.

Results: Mean follow-up times after mastectomy were 60 months for cases, 44 months for controls, and 73 months for cancer-free breasts. Locoregional recurrence was observed in 1.3 percent of cases (nine of 719 breasts) and 2.4 percent of controls (16 of 670 breasts). Breast cancer did not develop in any cancer-free breast. The cumulative 5-year locoregional recurrence rates were 1.6 percent and 4.1 percent for cases and controls, respectively. Systemic recurrence occurred in 2.4 percent of cases and 3.6 percent of controls (p = 0.514). There was no primary breast cancer in healthy breasts reconstructed with lipofilling.

Conclusions: The study results showed no increase in locoregional recurrence, systemic recurrence, or second breast cancer. These findings support the oncologic safety of lipofilling in breast reconstruction.

Introduction

A survey of the American Society of Plastic Surgeons in 2010 regarding the safety of autologous fat grafting (lipofilling) of the breast found that 49 percent of respondents considered the lack of evidence supporting the oncologic safety of lipofilling to be a significant obstacle to its use for breast reconstruction or cosmetic augmentation.[1] A concern is that adult adipose tissue–derived stem cells transferred with the lipoaspirate may reactivate dormant tumor cells within the breast or activate primary breast cancer.

Clinical and animal studies have shown conflicting results[2–5] as to whether lipofilling confers a higher risk for recurrence of breast cancer. Furthermore, it remains unknown which groups of patients might be more susceptible to any lipofilling-induced increase in the risk of recurrence. Although lipofilling of the breast is performed worldwide in thousands of patients per year, including as an alternative to implant placement for breast augmentation in some patients, there has been no study published with a control group regarding the oncologic safety of lipofilling in general or lipofilling of the breast. This lack of evidence has made many surgeons reluctant to offer lipofilling to patients, and surgeons who do perform lipofilling may have some concern that lipofilling may increase the risk for breast cancer recurrence.

The primary objective of this study was to determine whether lipofilling as an adjunct or primary breast reconstruction procedure increases the rate of locoregional recurrence of breast cancer. The secondary objective was to determine whether patients without breast cancer who underwent lipofilling after risk-reducing mastectomy had an increased risk of primary breast cancer.

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