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

Results

Our initial search of the plastic surgery database identified 1024 consecutive breasts reconstructed with lipofilling, 719 of them cancerous breasts (cases) and 305 of them cancer-free breasts (removed for breast cancer risk reduction). Of the 305 cancer-free breasts, BRCA status was available for 233 patients, of which 33 patients were carriers of the BRCA1/BRCA2 mutation. For the BRCA carriers, the mean follow-up time after mastectomy was 33.6 months and the mean time to lipofilling was 18.4 months. Through our search of the breast medical oncology database, we matched with the cases 670 cancerous breasts reconstructed without lipofilling (controls). The last patient follow-up was in November of 2014. Table 1 summarizes the patient and tumor characteristics. The mean follow-up time after mastectomy was significantly longer in cases (lipofilling) than in controls (no lipofilling) (59.6 months and 44.0 months, respectively; p < 0.001). The cases were older than the controls (mean age, 47.7 years and 46.5 years, respectively; p = 0.039). Cases and controls also differed with respect to pathologic stage, with cases more likely to have stage 0 or 1 cancer (p < 0.001). Tumor location and hormonal status (estrogen and progesterone receptor) were balanced between cases and controls. Controls were more likely to have HER2/neu-positive tumors (11.6 percent and 6.4 percent, respectively; p = 0.001) and more likely to receive chemotherapy (p < 0.001). Cases were more likely to receive hormonal therapy (p = 0.043).

Table 2 summarizes the characteristics of lipofilling (number of sessions and total volume injected) between cancer and benign cases. The two groups were similar with respect to the number of sessions. Total volume was greater in cases (p = 0.007).

Table 3 summarizes the differences in the risk of locoregional recurrence between lipofilling and no lipofilling in several subgroups. Overall, locoregional recurrence occurred in 1.3 percent of the cases (nine of 719 breasts) and 2.4 percent of the controls (16 of 670 breasts) (p = 0.455). We found that lipofilling did not affect the risk of locoregional recurrence in subgroups defined on the basis of pathologic stage, breast quadrant where the tumor was located, mastectomy, hormone receptor status, or use of chemotherapy or radiation therapy. We also used the multivariate Cox proportional hazards model in which we compared locoregional recurrence between cases and controls by adjusting for chemotherapy, radiation therapy, hormonal therapy, and clinical stage (p = 0.348). The only subgroup examined in which lipofilling was associated with an increased risk of locoregional recurrence was the subgroup treated with hormonal therapy, 1.4 percent and 0.5 percent for lipofilling and no lipofilling, respectively (p = 0.038). When a multivariate Cox proportional hazards model was performed only for hormonal therapy patients (adjusted for factors such as chemotherapy, radiation therapy, and clinical stage), lipofilling was still a significant factor with an increased risk of locoregional recurrence (p = 0.031).

Table 4 summarizes the differences in the risk of systemic recurrence between lipofilling and no lipofilling in several subgroups. Overall, systemic recurrence occurred in 2.4 percent of the cases (17 of 719 breasts) and 3.6 percent of the controls (24 of 670 breasts) (p = 0.514). There was no significant difference in the rates of systemic tumor recurrence between the breasts reconstructed with and without lipofilling overall or in any of the subgroups examined.

As shown in Figure 1, the cumulative 3-year and 5-year locoregional recurrence rates were 0.3 percent and 1.6 percent, respectively, for the cases (lipofilling) and 1.3 percent and 4.1 percent, respectively, for the controls (no lipofilling). The incidence of locoregional recurrence was 0.25 cases per 100 person-years for the cases and 0.65 cases per 100 person-years for the controls (p = 0.455). In the 305 healthy breasts reconstructed with lipofilling after risk-reducing mastectomy, no cases of breast cancer were observed during the follow-up period.

Figure 1.

Kaplan-Meier curves for locoregional recurrence–free survival for cases (cancer and lipofilling), controls (cancer and no lipofilling), and cancer-free breasts with lipofilling.

processing....