Skip to main content

Advertisement

SpringerLink
Log in

Meta-Analysis of the Oncological Safety of Autologous Fat Grafting After Breast Cancer on Basic Science and Clinical Studies

  • Original Article
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The purpose of the present study was to comprehensively evaluate the oncological safety of autologous fat grafting after breast cancer by combining experimental and clinical studies.

Methods

All studies published before August 2021 were collected by searching PubMed, Cochrane, Embase, Web of Science, SINOMED, and China National Knowledge Infrastructure. After screening the research and extracting the data, RevMan was used to perform the meta-analysis.

Results

Five basic science studies and 26 clinical studies, involving a total of 10,125 patients, were eventually included. In the basic science studies, adipose-derived stem cells promoted breast cancer growth, but fat grafting and adipose-derived stem cells plus fat grafting were not associated with breast cancer growth. An overall analysis of clinical studies showed that autologous fat grafting does not increase the risk of breast cancer recurrence. Subgroup analyses indicated that autologous fat grafting did not increase the risk of breast cancer recurrence in Asian or Caucasian patients, in patients undergoing breast-conserving surgery or modified radical mastectomy, in patients with in situ carcinomas or invasive carcinomas, or in patients undergoing postoperative radiotherapy.

Conclusion

This study combined experimental and clinical studies to conclude that autologous fat grafting does not increase the risk of breast cancer recurrence. However, the experimental results suggest that adipose-derived stem cells should be used with caution after breast cancer surgery.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Reference

  1. Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249

    Article  PubMed  Google Scholar 

  2. Wederfoort JLM, Hebels SA, Heuts EM et al (2022) Donor site complications and satisfaction in autologous fat grafting for breast reconstruction: a systematic review. J Plast Reconstr Aesthet Surg 75(4):1316–1327

    PubMed  Google Scholar 

  3. Agha RA, Fowler AJ, Herlin C et al (2015) Use of autologous fat grafting for breast reconstruction: a systematic review with meta-analysis of oncological outcomes. J Plast Reconstr Aesthet Surg 68:143–161

    PubMed  Google Scholar 

  4. Hassanshahi A, Hassanshahi M, Khabbazi S et al (2019) Adipose-derived stem cells for wound healing. J Cell Physiol 234:7903–7914

    CAS  PubMed  Google Scholar 

  5. Chen X, Yan L, Guo Z et al (2016) Adipose-derived mesenchymal stem cells promote the survival of fat grafts via crosstalk between the Nrf2 and TLR4 pathways. Cell Death Dis 7:e2369

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Schop SJ, Joosen MEM, Wolswijk T et al (2021) Quality of life after autologous fat transfer additional to prosthetic breast reconstruction in women after breast surgery: a systematic review. Eur J Surg Oncol 47:772–777

    CAS  PubMed  Google Scholar 

  7. Rosen KV, Gunnarsson GL, Gramkow C, et al. (2018) Fat grafting of the breast. Ugeskrift for laeger 180(31)

  8. Herly M, Orholt M, Larsen A et al (2018) Efficacy of breast reconstruction with fat grafting: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 71:1740–1750

    PubMed  Google Scholar 

  9. Piccotti F, Rybinska I, Scoccia E et al (2021) Lipofilling in breast oncological surgery: a safe opportunity or risk for cancer recurrence? Int J Mol Sci 22(7):3737

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Bertolini F, Petit JY, Kolonin MG (2015) Stem cells from adipose tissue and breast cancer: hype, risks and hope. Br J Cancer 112:419–423

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Gebremeskel S, Gencarelli J, Gareau AJ et al (2019) Promotion of primary murine breast cancer growth and metastasis by adipose-derived stem cells is reduced in the presence of autologous fat graft. Plast Reconstr Surg 143:137–147

    CAS  PubMed  Google Scholar 

  12. Kamat P, Schweizer R, Kaenel P et al (2015) Human adipose-derived mesenchymal stromal cells may promote breast cancer progression and metastatic spread. Plast Reconstr Surg 136:76–84

    CAS  PubMed  Google Scholar 

  13. Tukiama R, Vieira RAC, Facina G et al (2021) Oncologic safety of autologous fat grafting after breast cancer surgical treatment: a matched cohort study. Plast Reconstr Surg 148(1):11–20

    CAS  PubMed  Google Scholar 

  14. Vyas KS, DeCoster RC, Burns JC et al (2020) Autologous fat grafting does not increase risk of oncologic recurrence in the reconstructed breast. Ann Plast Surg 84:S405-s410

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Cason RW, Shammas RL, Broadwater G et al (2020) The influence of fat grafting on breast imaging after postmastectomy reconstruction: a matched cohort analysis. Plast Reconstr Surg 146:1227–1236

    CAS  PubMed  Google Scholar 

  16. Petit JY, Botteri E, Lohsiriwat V et al (2012) Locoregional recurrence risk after lipofilling in breast cancer patients. Ann Oncol 23:582–588

    CAS  PubMed  Google Scholar 

  17. Seth AK, Hirsch EM, Kim JY et al (2012) Long-term outcomes following fat grafting in prosthetic breast reconstruction: a comparative analysis. Plast Reconstr Surg 130:984–990

    CAS  PubMed  Google Scholar 

  18. Petit JY, Rietjens M, Botteri E et al (2013) Evaluation of fat grafting safety in patients with intra epithelial neoplasia: a matched-cohort study. Ann Oncol 24:1479–1484

    CAS  PubMed  Google Scholar 

  19. Longo B, Laporta R, Sorotos M et al (2014) Total breast reconstruction using autologous fat grafting following nipple-sparing mastectomy in irradiated and non-irradiated patients. Aesthet Plast Surg 38:1101–1108

    Google Scholar 

  20. Masia J, Bordoni D, Pons G et al (2015) Oncological safety of breast cancer patients undergoing free-flap reconstruction and lipofilling. Eur J Surgical Oncol J Eur Soc Surgical Oncol Br Assoc Surgical Oncol 41:612–616

    CAS  Google Scholar 

  21. Pinell-White XA, Etra J, Newell M et al (2015) Radiographic implications of fat grafting to the reconstructed breast. Breast J 21:520–525

    CAS  PubMed  Google Scholar 

  22. Kronowitz SJ, Mandujano CC, Liu J et al (2016) Lipofilling of the breast does not increase the risk of recurrence of breast cancer: a matched controlled study. Plast Reconstr Surg 137:385–393

    CAS  PubMed  Google Scholar 

  23. Mestak O, Hromadkova V, Fajfrova M et al (2016) Evaluation of oncological safety of fat grafting after breast-conserving therapy: a prospective study. Ann surgical oncol 23:776–781

    Google Scholar 

  24. Komorowska-Timek E, Turfe Z, Davis AT (2017) Outcomes of prosthetic reconstruction of irradiated and nonirradiated breasts with fat grafting. Plast Reconstr Surg 139:1e–9e

    CAS  PubMed  Google Scholar 

  25. Stumpf CC, Biazus JV, Zucatto FSAE et al (2017) Immediate reconstruction with autologous fat grafting: influence in breast cancerregional recurrence. Rev do Col Brasileiro de Cir 44:179–186

    Google Scholar 

  26. Krastev T, Van Turnhout A, Vriens E et al (2019) Long-term follow-up of autologous fat transfer vs conventional breast reconstruction and association with cancer relapse in patients with breast cancer. JAMA Surg 154:56–63

    PubMed  Google Scholar 

  27. Sorrentino L, Regolo L, Scoccia E et al (2019) Autologous fat transfer after breast cancer surgery: an exact-matching study on the long-term oncological safety. Eur J Surg Oncol 45:1827–1834

    PubMed  Google Scholar 

  28. Hanson SE, Kapur SK, Garvey PB et al (2020) Oncologic safety and surveillance of autologous fat grafting following breast conservation therapy. Plast Reconstr Surg 146:215–225

    CAS  PubMed  Google Scholar 

  29. Stumpf CC, Zucatto AE, Crespo Cavalheiro JA et al (2020) Oncologic safety of immediate autologous fat grafting for reconstruction in breast-conserving surgery. Breast Cancer Res Treat 180:301–309

    PubMed  Google Scholar 

  30. Chung J-H, Kim K-J, Jung SP et al (2021) Analysis of oncological safety of autologous fat grafting after immediate breast reconstruction. Gland Surg 10:584–594

    PubMed  PubMed Central  Google Scholar 

  31. Khan LR, Raine CR, Dixon JM (2017) Immediate lipofilling in breast conserving surgery. Eur J Surg Oncol 43:1402–1408

    CAS  PubMed  Google Scholar 

  32. Fertsch S, Hagouan M, Munder B et al (2017) Increased risk of recurrence associated with certain risk factors in breast cancer patients after DIEP-flap reconstruction and lipofilling-a matched cohort study with 200 patients. Gland Surg 6:315–323

    PubMed  PubMed Central  Google Scholar 

  33. Cohen O, Lam G, Karp N et al (2017) Determining the oncologic safety of autologous fat grafting as a reconstructive modality: an institutional review of breast cancer recurrence rates and surgical outcomes. Plast Reconstr Surg 140:382e–392e

    CAS  PubMed  Google Scholar 

  34. Gale KL, Rakha EA, Ball G et al (2015) A case-controlled study of the oncologic safety of fat grafting. Plast Reconstr Surg 135:1263–1275

    CAS  PubMed  Google Scholar 

  35. Kim HY, Jung BK, Lew DH et al (2014) Autologous fat graft in the reconstructed breast: fat absorption rate and safety based on sonographic identification. Arch Plast Surg 41:740–747

    PubMed  PubMed Central  Google Scholar 

  36. Laporta R, Longo B, Sorotos M et al (2015) Breast reconstruction with delayed fat-graft-augmented diep flap in patients with insufficient donor-site volume. Aesthet Plast Surg 39:339–349

    Google Scholar 

  37. Petit JY, Maisonneuve P (2016) Lipofilling of the breast does not increase the risk of recurrence of breast cancer: a matched controlled study. Plast Reconstr Surg 138:937E-938E

    CAS  PubMed  Google Scholar 

  38. Silva-Vergara C, Fontdevila J, Weshahy O et al (2017) Breast cancer recurrence is not increased with lipofilling reconstruction: a case-controlled study. Ann Plast Surg 79:243–248

    CAS  PubMed  Google Scholar 

  39. Silva MMA, Kokai LE, Donnenberg VS et al (2019) Oncologic safety of fat grafting for autologous breast reconstruction in an animal model of residual breast cancer. Plast Reconstr Surg 143:103–112

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Lee JS, Eo P, Kim MC et al (2019) Effects of stromal vascular fraction on breast cancer growth and fat engraftment in NOD/SCID mice. Aesthet Plast Surg 43:498–513

    Google Scholar 

  41. Orbay H, Hinchcliff KM, Charvet HJ et al (2018) Fat graft safety after oncologic surgery: addressing the contradiction between in vitro and clinical studies. Plast Reconstr Surg 142:1489–1499

    CAS  PubMed  Google Scholar 

  42. Chen Y, Li G (2021) Safety and effectiveness of autologous fat grafting after breast radiotherapy: a systematic review and meta-analysis. Plast Reconstr Surg 147:1–10

    PubMed  Google Scholar 

  43. Krastev TK, Alshaikh GAH, Hommes J et al (2018) Efficacy of autologous fat transfer for the correction of contour deformities in the breast: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 71:1392–1409

    PubMed  Google Scholar 

  44. Park J, Euhus DM, Scherer PE (2011) Paracrine and endocrine effects of adipose tissue on cancer development and progression. Endocr Rev 32:550–570

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Choi J, Cha YJ, Koo JS (2018) Adipocyte biology in breast cancer: from silent bystander to active facilitator. Prog Lipid Res 69:11–20

    CAS  PubMed  Google Scholar 

  46. Largo RD, Tchang LA, Mele V et al (2014) Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: a systematic review. J Plast Reconstr Aesthet Surg 67:437–448

    PubMed  Google Scholar 

  47. Claro F Jr, Figueiredo JC, Zampar AG et al (2012) Applicability and safety of autologous fat for reconstruction of the breast. Br J Surg 99:768–780

    PubMed  Google Scholar 

  48. Adelipour M, Allameh A, Sheikhi A et al (2021) Role of the mesenchymal stem cells derived from adipose tissue in changing the rate of breast cancer cell proliferation and autophagy, in vitro and in vivo. Iran J Basic Med Sci 24:98–107

    PubMed  PubMed Central  Google Scholar 

  49. Moskaleva EY, Semochkina YP, Shuvatova VG et al (2019) Mesenchymal stem cells from mouse adipose tissue stimulate tumor growth. Bull Exp Biol Med 167:145–149

    PubMed  Google Scholar 

  50. Tayeh S, Muktar S, Wazir U et al (2020) Is autologous fat grafting an oncologically safe procedure following breast conserving surgery for breast cancer? comprehensive review. J Invest Surg 35(2):390–399

    PubMed  Google Scholar 

  51. Tayeh S, Carmichael AR, Darr H et al (2020) The oncological safety of autologous fat grafting after breast conserving surgery for breast cancer: a systematic review, meta- analysis and meta regression analysis of observational studies. Cancer Res 80:4–13

    Google Scholar 

  52. Wang K, Dai Y, Pan Y et al (2020) Local-regional recurrence risk after autologous fat grafting in breast cancer patients: a systematic review and meta-analysis. J Surg Oncol 121:435–440

    PubMed  Google Scholar 

Download references

Funding

The authors have no financial interest to declare concerning the content of this article.

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China

    Kai Wang, Zhou Yu, Jiezhang Tang, Juanli Dang, Huichen Li, Jizhong Yang & Han Peng

  2. Department of Plastic Surgery, Medical School, The Second Affiliated Hospital, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, China

    Chenggang Yi

  3. Department of Plastic Surgery, 987 Hospital of Joint Logistics Support Force, P.L.A., No. 45 Dongfeng Road, Baoji, China

    Xiangke Rong

Authors
  1. Kai Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhou Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiangke Rong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiezhang Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juanli Dang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Huichen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jizhong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Han Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chenggang Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chenggang Yi.

Ethics declarations

Conflict of interest

The authors have declared that no competing interest exists.

Informed Consent

For this type of study informed consent is not required.

Human and Animal Rights Statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, K., Yu, Z., Rong, X. et al. Meta-Analysis of the Oncological Safety of Autologous Fat Grafting After Breast Cancer on Basic Science and Clinical Studies. Aesth Plast Surg 47, 1245–1257 (2023). https://doi.org/10.1007/s00266-022-03217-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-022-03217-7

Keywords

Search

Navigation