Oncological outcomes of lipofilling in breast reconstruction: a matched cohort study with 250 patients

Background and Objectives: Lipofilling is a commonly performed procedure worldwide for breast augmentation and correction of breast contour deformities. In breast reconstruction, fat grafting has been used as a single reconstructive technique, as well as in combination with other procedures. The aim of the present study is to systematically review available studies in the literature describing the combination of implant-based breast reconstruction and fat grafting, focusing on safety, complications rate, surgical sessions needed to reach a satisfying reconstruction, and patient-reported outcomes. Materials and Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol. A systematic review of the literature up to April 2022 was performed using Medline, Embase, and Cochrane Library databases. Only studies dealing with implant-based breast reconstruction combined with fat grafting were included. Results: We screened 292 articles by title and abstract. Only 48 articles were assessed for full-text eligibility, and among those, 12 studies were eventually selected. We included a total of 753 breast reconstructions in 585 patients undergoing mastectomy or demolitive breast surgeries other than mastectomy (quadrantectomy, segmentectomy, or lumpectomy) due to breast cancer or genetic predisposition to breast cancer. Overall, the number of complications was 60 (7.9%). The mean volume of fat grafting per breast per session ranged from 59 to 313 mL. The mean number of lipofilling sessions per breast ranged from 1.3 to 3.2. Conclusions: Hybrid breast reconstruction shows similar short-term complications to standard implant-based reconstruction but with the potential to significantly decrease the risk of long-term complications. Moreover, patient satisfaction was achieved with a reasonably low number of lipofilling sessions (1.7 on average).

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“…Studies have widely demonstrated the oncologic safety of fat grafting for breast reconstruction [5][6][7]44,45].…”

Section: Discussionmentioning

confidence: 99%

“…Although initial skepticism has surrounded the oncological safety of fat grafting in breast reconstruction, studies found strong evidence demonstrating no increase in breast cancer recurrence or mortality [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Outcomes in Hybrid Breast Reconstruction: A Systematic Review

et al. 2022

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“…Some included small population samples, which makes the interpretation of their results difficult. 35,37,38 Other articles focused solely on specific tumor characteristics or specific breast reconstruction procedures. For instance, Myckatyn et al focused only on invasive ductal cancer cases, and their patient population mostly included implant-based breast reconstruction, 39 whereas Masia et al 40 and Fertsch et al 41 focused only on free-flap–based breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Single-Center Oncologic Outcome of Fat Transfer for Breast Reconstruction Following Mastectomy in 1000 Cancer Cases – A Matched Case-Control Study

Sorotos

Paolini

D’Orsi

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Autologous fat transfer has an important role in breast reconstructive surgery. Nevertheless, some concerns remain with regard to its oncologic safety. The authors present a single-center, case-matching study analyzing the impact of autologous fat transfer in the cumulative incidence of local recurrences. Methods: From a prospectively maintained database, the authors identified 902 patients who underwent 1025 breast reconstructions from 2005 to 2017. Data regarding demographics, tumor characteristics, surgery details, and follow-up were collected. Exclusion criteria were patients with distant metastases at diagnosis, recurrent tumor, or incomplete data regarding primary tumor; and patients who underwent prophylactic mastectomies and breast-conserving operations. Statistical analysis was conducted to evaluate the impact of the variables on the incidence of local recurrence. A value of p < 0.05 was considered statistically significant. Results: After 1:n case-matching, we selected 919 breasts, of which 425 patients (46.2 percent) received at least one autologous fat transfer session versus 494 control cases (53.8 percent). Local recurrences had an overall rate of 6.8 percent, and we found local recurrences in 14 autologous fat transfer cases (3.0 percent) and 54 controls (9.6 percent). Statistical analysis showed that autologous fat transfer did not increase the risk of local recurrences (hazard ratio, 0.337; CI, 0.173 to 0.658; p = 0.00007). Multivariate analysis identified invasive ductal carcinoma subtype and lymph node metastases to have an increased risk of local recurrences (hazard ratio >1). Conversely, positive hormonal receptor status was associated with a reduced risk of events (hazard ratio <1). Conclusions: Autologous fat transfer was not associated with a higher probability of locoregional recurrence in patients undergoing breast reconstruction; therefore, it can be safely used for total breast reconstruction or aesthetic refinements. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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“…In addition, the tissue modeling can be specific for each patient’s anatomic features, such as the thorax width, the contralateral breast volume, or the desired volume in case of bilateral mastectomies and the overall appearance. However, donor site outcomes, surgery duration and safety concerns have emerged regarding the risk of cancer recurrences due to growth factors within the fat graft and the postoperative calcifications ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Autogenous breast reconstruction for total mastectomies: a narrative review

Laurent,

Trifan,

Danino

et al. 2024

Ann Transl Med

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Background and Objective Mastectomies have a significant socio-psychological impact, motivating patients to undergo breast reconstruction. Initially, silicone implants were used to reconstruct the breast. However, breast implants have been the subject of successive crises throughout the years. Indeed, rupture, silicone bleeding, and capsular contracture remain topical. In 2019, the BIOCELL textured breast implants was banned and recalled due to the discovery of the breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). More recently, the breast implant illness has been depicted in the media. To cope with these issues and to respond to some patients’ expectations for a natural reconstruction, plastic surgeons have developed autogenous solutions for breast reconstruction. Since Taylor’s research on angiosomes, the development of the microsurgery and more recently fat grafting, autogenous breast reconstruction has known a tremendous expansion. Autologous breast reconstruction allows a more natural feeling and texture. This narrative review aims to provide to the readers a comprehensive and updated evidence-based overview of state of the art about autologous breast reconstruction after total mastectomy. Methods We conducted a narrative review of the literature searching for papers published between January 2010 and December 2022. The MeSH terms with different combinations were used to identify articles for inclusion. After screening article titles and abstracts independently by three authors, 66 papers were included in this review. Key Content and Findings In this review, the authors describe and discuss the different autogenous techniques in breast reconstruction. Conclusions Autologous reconstructions provide very satisfactory, durable, and reliable results with relatively low complication rates. Deep inferior epigastric perforator (DIEP) flaps, latissimus dorsi flaps and autologous fat grafting are the most common type of autogenous breast reconstructions.

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Oncological outcomes of lipofilling in breast reconstruction: a matched cohort study with 250 patients

Cited by 8 publications

References 33 publications

Outcomes in Hybrid Breast Reconstruction: A Systematic Review

Outcomes in Hybrid Breast Reconstruction: A Systematic Review

Single-Center Oncologic Outcome of Fat Transfer for Breast Reconstruction Following Mastectomy in 1000 Cancer Cases – A Matched Case-Control Study

Autogenous breast reconstruction for total mastectomies: a narrative review

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