Oncologic safety of immediate autologous fat grafting for reconstruction in breast-conserving surgery

• Published in: Breast cancer research and treatment Vol. 180; no. 2; pp. 301 - 309
• Main Authors: Stumpf, Camile Cesa, Zucatto, Ângela Erguy, Cavalheiro, José Antônio Crespo, de Melo, Marcia Portela, Cericato, Rodrigo, Damin, Andréa Pires Souto, Biazús, Jorge Villanova
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2020; Springer; Springer Nature B.V
• Subjects: Adipose Tissue - transplantation; Adult; Aged; Aged, 80 and over; Autografts; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer; Cancer research; Case-Control Studies; Female; Follow-Up Studies; Humans; Lumpectomy; Lymph nodes; Mammaplasty - methods; Mastectomy; Mastectomy, Segmental - methods; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Oncology; Oncology, Experimental; Patient Safety; Retrospective Studies; Review; Risk factors; Safety; Safety and security measures; Surgery; Surgery, Plastic; Survival; Transplantation, Autologous - methods; Tumors; Recurrence; Breast cancer; Immediate breast reconstruction; Breast conservative surgery; Autologous fat grafting
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-020-05554-0

Importance
Autologous fat grafting (AFG), or lipofilling, has been used for immediate reconstruction at the time of breast-conserving surgery in order to achieve a satisfactory cosmetic outcome in patients with breast cancer and an unfavorable tumor-to-breast volume ratio or unfavorable tumor location. However, the oncologic safety of this technique is still unclear.
Objective
To determine whether AFG performed simultaneously with breast-conserving surgery is associated with differences in local relapse rates and disease-free survival.
Design
Matched retrospective cohort study.
Setting
Tertiary referral center.
Participants
Patients undergoing breast-conserving surgery with or without AFG between 2004 and 2016 were retrospectively enrolled and matched for age, staging, grade, tumor histology, and tumor immunohistochemical profile.
Main outcome(s) and measure(s)
The cumulative incidence of locoregional recurrence (LRR) and disease-free survival were the primary end points, while distant recurrence and overall survival were the secondary end points.
Results
A total of 320 patients were followed. Cases were matched with controls at a 1:4 ratio. There was no difference in LRR or distant recurrence of breast cancer between the two groups. The annual LRR rate was 0.86% in patients who received immediate AFG vs. 0.7% in patients undergoing breast-conserving surgery alone (
p
 ≥ 0.05). Number of lymph nodes was the sole independent risk factor for local recurrence (
p
 = 0.045). No significant differences in disease-free survival rates were found between the groups.
Conclusions and relevance
At a mean follow-up of 5 years, no significant differences in locoregional recurrence rates were found between patients who received immediate AFG and those who underwent breast-conserving surgery alone. These findings corroborate previous research demonstrating the oncological safety of immediate AFG reconstruction, further suggesting that this technique as a safe, effective way to achieve optimal cosmetic outcomes in primary breast cancer surgery without jeopardizing oncologic outcomes.