Meta-analysis of the oncological safety of autologous fat transfer after breast cancer

Krastev, Todor K.; Schop, Sander S J; Hommes, Juliëtte; Piatkowski, Andrzej; Heuts, E. M.; Hulst, René R W J van der

doi:10.1002/bjs.10887

Cited by 60 publications

(36 citation statements)

References 78 publications

(189 reference statements)

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“…At least 41 non-overlapping studies have previously reported LRR and DM rates after AFT, but the oncologic safety of lipofilling still remains debated, despite the fact that the great majority of evidence suggests similar outcomes between AFT and control patients [7]. We observed that LRR and DM rates were similar between AFT and control patients after exact matching according to baseline cancer-related features.…”

Section: Discussionmentioning

confidence: 53%

“…After adjusting for confounders in a regression model accounting for adjuvant treatments and BMS, AFT was still not associated with increased LRR (HR 0.87, p=0.69) or DM (HR 0.82, p=0.55). Recently, a large meta-analysis on 4,292 patients demonstrated a non-significant incidence rate difference in LRR of -0.15% per year between AFT and control patients, providing robust evidence of AFT safety after breast cancer [7]. However, the mean follow-up from AFT procedure was only 2.7 years for included studies.…”

Section: Discussionmentioning

confidence: 99%

“…This technique is widely adopted by breast surgeons, and its use has risen over time [3]. However, concerns about an increased risk of cancer recurrence have been raised, and the oncological safety of AFT has been questioned [4][5][6][7]. Indeed, adipose-derived mesenchymal stem cells are transferred together with adipose tissue during AFT, stimulating angiogenesis and stroma remodeling, thus being responsible for the cosmetic success of lipofilling [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, preclinical studies showed that adipocytes and adipokines, being part of the tumor microenvironment, may play a role in cancer occurrence and progression, possibly being related to recurrence [10][11][12][13]. A few case-control studies based on large populations are available today, which suggest that local recurrence rates do not seem increase after AFT [7,14]. At the same time, rigorous evidence analyzing long-term oncologic outcomes and which also considers adjuvant treatments and biomolecular subtypes (BMS) of breast cancer are still scarce [14].…”

Section: Introductionmentioning

confidence: 99%

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Autologous fat transfer after breast cancer surgery: An exact-matching study on the long-term oncological safety

Sorrentino

Regolo

Scoccia

et al. 2019

European Journal of Surgical Oncology

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Introduction: Autologous fat transfer (AFT) is widely adopted for breast reconstruction, but its longterm oncologic safety is still not clearly established. The aim of the present study was to compare the 10-year loco-regional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in AFT vs. control patients, also evaluating the impact of AFT in different intrinsic molecular subtypes of breast cancer. Materials and Methods: 464 AFT patients were exactly matched with a cohort of 3,100 control patients treated between 2007 and 2017. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant/neoadjuvant treatments. End-points were analyzed both overall and in each molecular subtype. Results: LRR occurred in 6.4% of AFT and in 5.0% of control patients (p=0.42), while DM were observed respectively in 7.7% and 5.4% of cases (p=0.20). AFT showed no effect on the 10-year LRR-free survival probability (adjusted HR 0.87, 95%CI 0.43-1.76, p=0.69) or the 10-year DM-free survival probability (adjusted HR 0.82, 95%CI 0.43-1.57, p=0.55). Luminal A patients treated by AFT showed a decreased LRR-free survival probability (HR 2.38, 95%CI 0.91-6.17, Log-Rank p=0.07), which was significantly lower than controls after 80 months (Log-Rank p=0.02). No differences in the 10-year event-free survival probability were found in Luminal B, HER2-positive or triple-negative patients. Conclusion: AFT does not increase breast cancer recurrence, with the possible exception of late LRRs for Luminal A patients, but further clinical and preclinical data are required to better clarify this data. The use of AFT should not be discouraged.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Autologous fat transfer after breast cancer surgery: An exact-matching study on the long-term oncological safety

Sorrentino

Regolo

Scoccia

et al. 2019

European Journal of Surgical Oncology

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“…Several metaanalyses and systematic reviews have unanimously concluded that autologous fat transfer does not lead to an increased rate of locoregional breast cancer recurrence. [65][66][67][68][69][70] However, as mentioned previously, a higher rate of biopsies exists with patients who have undergone fat grafting to the breasts compared with the general population, as fat necrosis may be difficult to distinguish radiographically from breast cancer. 21,22 That is, to date there is a substantial amount of evidence that fat grafting remains a safe and highly effective option for cosmetic breast surgery in patients with a history of breast cancer.…”

Section: Oncological Safetymentioning

confidence: 99%

Application of Fat Grafting in Cosmetic Breast Surgery

Davis

Perdanasari

Abu‐Ghname

et al. 2020

Seminars in Plastic Surgery

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The role of fat grafting to the breasts has evolved in the recent past, gaining several new applications within both reconstructive and aesthetic surgery. Initially used for reconstructive purposes to fill lumpectomy defects or to correct residual contour deformities after breast reconstruction, it has since made its way into cosmetic breast surgery and has grown to encompass a wide variety of new indications. Fat grafting in aesthetic breast surgery may be performed as a form of primary autologous breast augmentation or as an adjunct to implant-based breast augmentation to disguise implant edges. It may also be used to provide added volume after explant surgery or to provide improvements in breast contour alongside mastopexy techniques. In this article, we will review the current applications of fat grafting in aesthetic breast surgery and provide an up-to-date summary of its reported outcomes, safety, and complications.

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