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

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Abstract

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.

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Funding

The authors have no financial relationships relevant to this article to disclose.

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Authors and Affiliations

  1. Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro 2350/600C, Porto Alegre, RS, 90035-903, Brazil

    Camile Cesa Stumpf, Andréa Pires Souto Damin & Jorge Villanova Biazús

  2. Department of Gynecology and Obstetrics, Medical School, UFRGS, Porto Alegre, RS, Brazil

    Andréa Pires Souto Damin & Jorge Villanova Biazús

  3. Mastology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil

    Ângela Erguy Zucatto, José Antônio Crespo Cavalheiro, Marcia Portela de Melo, Rodrigo Cericato, Andréa Pires Souto Damin & Jorge Villanova Biazús

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  1. Camile Cesa Stumpf
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  2. Ângela Erguy Zucatto
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  3. José Antônio Crespo Cavalheiro
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  7. Jorge Villanova Biazús
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Contributions

Conception and design: CCS, JVB. Analysis and interpretation: CCS, AEZ. Data collection: CCS. Writing the article: CCS. Critical revision of the article: CCS, AEZ, ASPD. Final approval of the article: CCS, AEZ. Statistical analysis: CCS, JACC. Overall responsibility: CCS, RC, MPM. All authors have read and approved the final version of the article.

Corresponding author

Correspondence to Camile Cesa Stumpf.

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Conflict of interest

The authors have no conflicts of interest to disclose. Camile Cesa Stumpf had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Inform consent

All information is obtained from the electronic hospital record. Addicional informed consent was obtained from hospital where information and databases were collected. The researchers are committed to preserving the privacy of patients and they also agree that the information was used exclusively to study.

Research involving human participants and/or animals

For retrospective cohort study, individual formal consent is not required.

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Stumpf, C.C., Zucatto, Â.E., Cavalheiro, J.A.C. et al. Oncologic safety of immediate autologous fat grafting for reconstruction in breast-conserving surgery. Breast Cancer Res Treat 180, 301–309 (2020). https://doi.org/10.1007/s10549-020-05554-0

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