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Fat grafting for breast cancer deformities

Woman breasts

A new study helps put to rest the highly controversial topic of whether treating breast deformities in breast cancer patients with autologous fat transfer increases risk of cancer relapse.

It doesn’t, according to the study of 300 affected breasts reconstructed with fat grafting compared to 300 matched controls receiving conventional breast reconstruction.

Researchers in the Netherlands found no significant difference in locoregional recurrence rate in a five-year follow-up, according to the study published online October 10, 2018 in JAMA Surgery.

Neoadjuvant tumor-shrinking drug therapies have made preserving the breast in most breast cancer patients more feasible. And while surgeons often can restore breast shape and volume post breast conserving therapy and mastectomy, small sometimes equally disfiguring deformities might remain. Autologous fat transfer, or injecting a patient’s liposuctioned fat into the soft tissue deformity, is minimally invasive, results in high patient and doctor satisfaction and might induce tissue regeneration post radiotherapy, according to the paper.

But because patients and doctors fear that autologous fat transfer to the breast might interfere with breast cancer imaging and increase risk of cancer recurrence, fat grafting has been used limitedly in breast cancer patients.

Studies have addressed the first concern of imaging. Researchers have shown that macrocalcifications resulting from post autologous fat transfer fat necrosis don’t seem to get in the way of breast cancer detection. However, a large number of studies looking at breast cancer recurrence after autologous fat transfer haven’t provided convincing evidence of the treatment’s safety.

Researchers in this study matched each patient undergoing autologous fat transfer with a control matched for age, type of cancer surgery, tumor invasiveness and disease stage.
In their survival analysis, researchers found a slightly lower, though statistically insignificant, locoregional recurrence rate in autologous fat transfer cases compared with controls. They didn’t find notable differences in the rates of distant recurrences.

However, researchers found a 4-fold higher overall mortality in the control group. The breast cancer-specific mortality was more than twice as high in the control group compared to those who received autologous fat transfer. The reason for this should be evaluated in future studies, according to the authors. 

In a study-associated commentary, U.S. authors write that autologous fat transfer is rarely mentioned as an option when patients meet with plastic surgeons to discuss reconstruction after breast cancer because of questions about cancer risk. But this and other work has cleared the potential theoretical oncological risk associated with autologous fat transfer-based reconstruction, according to the commentary.

“Autologous fat transfer is a less-invasive breast reconstruction alternative that challenges the well-entrenched standards,” the commentary authors write.