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Fat grafting for breast reconstruction does not increase cancer recurrence risk

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October 10, 2018

Women who underwent autologous fat transfer for reconstruction after breast cancer surgery did not appear at increased risk for locoregional or distant recurrence, according to a case-matched, retrospective review of medical records.

Fat transfer reconstruction also was associated with lower mortality rates than conventional breast reconstruction.

Autologous fat transfer, also called fat grafting, is a process in which a clinician injects a patient’s liposuctioned fat, often harvested from the abdomen or upper legs, into soft tissue deformities that may occur during breast cancer surgery.

“Despite its clinical benefits and favorable regenerative properties, the application of autologous fat transfer in patients with breast cancer has been restricted by two main factors: the fear that it can interfere with breast cancer imaging and that intentionally placing regenerative cells in a previous tumor bed could increase the risk of locoregional recurrence,” Todor Krastev, MD, a PhD candidate in the department of plastic, reconstructive and hand surgery at Maastricht University Medical Centre, and colleagues wrote. “While studies have already demonstrated that macrocalcifications resulting from fat necrosis after autologous fat transfer do not seem to hinder the detection of breast cancer, the question regarding the risk of recurrence remains a topic of much debate.”

Krastev and colleagues used data from Tergooi Hospital in the Netherlands to assess associations between breast cancer recurrence and autologous fat transfer.

Investigators used age, type of oncologic surgery, tumor invasiveness and disease stage to match 287 patients (mean age, 48.1 years) who underwent autologous fat transfer for reconstruction of 300 affected breasts with 300 control patients (mean age, 49.4 years) who received either conventional reconstruction on none.

Mean follow-up for patients who received autologous fat transfer was 9.3 years, including 5 years after grafting. Mean follow-up for the control group was 8.6 years following primary surgery.

Results showed no significant difference in recurrences between the two cohorts. Researchers observed eight locoregional recurrences among the fat transfer cohort compared with 11 recurrences among the control cohort (HR = 0.63; 95% CI, 0.25-1.6).

The risk for distant recurrence also did not significantly differ (HR = 0.94; 95% CI, 0.52-1.72).

Researchers did not observe increased risk for recurrence in subgroup analyses.

Further, those who underwent autologous fat transfer demonstrated a reduced risk for overall mortality (HR 0.2; 95% CI, 0.09-0.44) and breast cancer-specific mortality (HR = 0.37; 95% CI, 0.15-0.91) compared with the control group. Researchers said these differences could not be adequately explained by the influence of confounders.

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“The conflicting evidence from the molecular and clinical arenas has engendered divergent and even polarized opinions among plastic surgeons as well as oncologists on whether the clinical benefits of autologous fat transfer outweigh its potential risks,” the researchers wrote. “Despite the large number of publications on this topic, studies have been unable to provide convincing evidence, largely owing to their limited methodologic quality and the lack of suitable control groups.”

These findings may impact patients’ reconstruction decisions, Roger K. Khouri, MD, of the Miami Breast Center and the department of surgery at Florida International University, and colleagues wrote in an accompanying editorial.

“Now that autologous fat transfer has been proven safe and effective, the standard of care should reflect this latest addition,” they wrote. “Patients with breast cancer have a third reconstructive option [in addition to implant-based and tissue flap-based reconstruction], and plastic surgeons should present all three and discuss the advantages and disadvantages of each. Patients will then be able to choose the option that aligns most closely with their values and goals.” – by Cassie Homer

Disclosures: Krastev and colleagues report no relevant financial disclosures. Khouri reports inventing the Brava breast expansion device and the Lipografter (MTF Biologics), described by the manufacturer as a medical device for harvesting and grafting autologous fat, as well as ownership interest with Lipocosm and royalties from the sale of the Lipografter. The other editorial authors report no relevant financial disclosures.