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Fat necrosis after breast-conserving oncoplastic surgery

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Abstract

Background

Fat necrosis is a subjective early as well as delayed complication, which sometimes mimics local recurrence and ruins the quality of life by pain and poor cosmetic result. While, the frequency and severity of fat necrosis are important issues that breast surgeons should explain to the patient, these data are not revealed well.

Methods

A total of 1476 patients who underwent breast surgery from January 2000 to December 2012 were enrolled in the present study. We assessed fat necrosis by mammographic and physical findings and created grading criteria: Grade (G) 0, no fat necrosis; G1, no symptomatic fat necrosis (mammographic dystrophic calcification); G2, mild symptomatic necrosis (mammographic dystrophic necrosis with tumor); G3, severe symptomatic necrosis (mammographic dystrophic necrosis with pain or skin change); and G4, symptomatic necrosis requiring surgical intervention.

Results

Of the 1476 patients enrolled, 393 (27%) underwent mastectomy, and 1083 (73%) underwent breast-conserving surgery. We achieved a high rate of breast-conserving surgery at a total rate of 73% over the study period and maximum rate of 88% in 2010, using oncoplastic procedures. We mainly adopted a pedicled fat flap (417/1083; 39%) and a free dermal fat flap (40/1083; 3.7%). Among the 626 patients who underwent partial resection with no replacement for the defect, G1–G2 fat necrosis was seen in 29/626 (4.6%). While, the incidence of fat necrosis with pedicled fat flap and free dermal fat graft was 68/417 (16%) and 40/40 (100%), respectively, showing a significant difference (p < 0.01). Furthermore, the incidence of G3–G4 fat necrosis was significantly higher with free dermal fat grafts (25%; 10/40) than with pedicled flap (2.9%; 12/417) (p < 0.01). Among pedicled flaps, the incidence of fat necrosis with inframammary adipofascial flaps was 56% (14/25) which was higher than that with lateral epidermal fat flaps (12%; 33/276) (p < 0.01), and rotation of surrounding breast tissues (8%; 21/116) (p < 0.01). The incidence of G3 fat necrosis was also high at 20% (5/25) in inframammary adipofascial flaps.

Conclusions

Breast-conserving oncoplastic surgery carries a risk of fat necrosis as a delayed complication. The incidence rate and severity of fat necrosis with each procedure should be assessed. We should select fat grafts with a good blood supply to replace defects of breast-conserving therapy.

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References

  1. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

    Article  CAS  Google Scholar 

  2. Anderson SJ, Wapnir I, Dignam JJ, Fisher B, Mamounas EP, Jeong JH, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27:2466–73.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fisher B, Bryant J, Dignam JJ, Wickerham DL, Mamounas EP, Fisher ER, et al. Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol. 2002;20:4141–9.

    Article  CAS  PubMed  Google Scholar 

  4. Fisher B, Jeong JH, Anderson S, Wolmark N. Treatment of axillary lymph node-negative, estrogen receptor-negative breast cancer: updated findings from National Surgical Adjuvant Breast and Bowel Project clinical trials. J Natl Cancer Inst. 2004;96:1823–31.

    Article  PubMed  Google Scholar 

  5. Nose T, Komoike Y, Yoshida K, Koizumi M, Motomura K, Kasugai T, et al. A pilot study of wider use of accelerated partial breast irradiation: intraoperative margin-directed re-excision combined with sole high-dose-rate interstitial brachytherapy. Breast Cancer. 2006;13:289–99.

    Article  PubMed  Google Scholar 

  6. (2018) Available at: https://memberpage.jbcs.gr.jp/uploads/ckfinder/files/nenjitouroku/2015kakutei.pdf. Accessed Feb 2018.

  7. Nakamura S, Kenjo H, Nishio T, Kazama T, Doi O, Suzuki K. Efficacy of 3D-MR mammography for breast conserving surgery after neoadjuvant chemotherapy. Breast Cancer. 2002;9:15–9.

    Article  PubMed  Google Scholar 

  8. Solin LJ, Orel SG, Hwang WT, Harris EE, Schnall MD. Relationship of breast magnetic resonance imaging to outcome after breast-conservation treatment with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ. J Clin Oncol. 2008;26:386–91.

    Article  PubMed  Google Scholar 

  9. Morrow M, Harris JR, Schnitt SJ. Surgical margins in lumpectomy for breast cancer—bigger is not better. N Engl J Med. 2012;367:79–82.

    Article  PubMed  Google Scholar 

  10. Azu M, Abrahamse P, Katz SJ, Jagsi R, Morrow M. What is an adequate margin for breast-conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol. 2010;17:558–63.

    Article  PubMed  Google Scholar 

  11. Masetti R, Di Leone A, Franceschini G, Magno S, Terribile D, Fabbri MC, et al. Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview. Breast J. 2006;12:174-80.

    Article  Google Scholar 

  12. Criscitiello C, Curigliano G, Burstein HJ, Wong S, Esposito A, Viale G, et al. Breast conservation following neoadjuvant therapy for breast cancer in the modern era: Are we losing the opportunity? Eur J Surg Oncol. 2016;42:1780–6.

    Article  CAS  PubMed  Google Scholar 

  13. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353:1673–84.

    Article  CAS  PubMed  Google Scholar 

  14. Noguchi M, Inokuchi M. “Moving window” operation for breast-conserving surgery. Breast Cancer. 2010;17:56–60.

    Article  PubMed  Google Scholar 

  15. Takeda M, Ishida T, Ohnuki K, Suzuki A, Kiyohara H, Moriya T, et al. Breast conserving surgery with primary volume replacement using a lateral tissue flap. Breast Cancer. 2005;12:16–20.

    Article  PubMed  Google Scholar 

  16. Ogawa T, Hanamura N, Yamashita M, Kimura H, Kashikura Y. Long-term results of breast volume replacement using an inframammary adipofascial flap after breast-conserving surgery. Breast Cancer. 2014;21:635–40.

    Article  PubMed  Google Scholar 

  17. Russo AL, Taghian AG. Fat necrosis of the breast in the accelerated partial breast irradiation era: the need for a universal grading system. Breast Cancer Res Treat. 2013;140:1–11.

    Article  CAS  PubMed  Google Scholar 

  18. Robertson C, Arcot Ragupathy SK, Boachie C, Dixon JM, Fraser C, Hernandez R, et al. The clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment for primary breast cancer: systematic reviews registry database analyses and economic evaluation. Health Technol Assess. 2011;15:v–vi, 1–322.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. (2018) Available at: http://jbcs.gr.jp/guidline/guideline/g1/. Accessed Mar 2018.

  20. Nakagomi H, Furuya K, Hinata M, Kobayashi K, Ohmori M, Kobayashi K. Lateral thoracoaxillar dermal fat flap as an oncoplastic technique for breast-conserving surgery. Jpn J Breast Cancer. 2009;24:363–7.

    Google Scholar 

  21. Kijima Y, Koriyama C, Fujii T, Hirokaga K, Ishigure K, Kaneko T, et al. Immediate breast volume replacement using a free dermal fat graft after breast cancer surgery: multi-institutional joint research of short-term outcomes in 262 Japanese patients. Gland Surg. 2015;4:179–94.

    PubMed  PubMed Central  Google Scholar 

  22. Lovey K, Fodor J, Major T, Szabo E, Orosz Z, Sulyok Z, et al. Fat necrosis after partial-breast irradiation with brachytherapy or electron irradiation versus standard whole-breast radiotherapy—4-year results of a randomized trial. Int J Radiat Oncol Biol Phys. 2007;69:724–31.

    Article  PubMed  Google Scholar 

  23. Clarke D, Curtis JL, Martinez A, Fajardo L, Goffinet D. Fat necrosis of the breast simulating recurrent carcinoma after primary radiotherapy in the management of early stage breast carcinoma. Cancer. 1983;52:442–5.

    Article  CAS  PubMed  Google Scholar 

  24. Budrukkar A, Jagtap V, Kembhavi S, Munshi A, Jalali R, Seth T, et al. Fat necrosis in women with early-stage breast cancer treated with accelerated partial breast irradiation (APBI) using interstitial brachytherapy. Radiother Oncol. 2012;103:161–5.

    Article  PubMed  Google Scholar 

  25. Piroth MD, Fischedick K, Wein B, Heindrichs U, Piroth DM, Holy R, et al. Fat necrosis and parenchymal scarring after breast-conserving surgery and radiotherapy with an intraoperative electron or fractionated, percutaneous boost: a retrospective comparison. Breast Cancer. 2014;21:409–14.

    Article  PubMed  Google Scholar 

  26. Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930–42.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was approved by the institutional review board at Yamanashi Central Hospital.

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Authors and Affiliations

  1. Department of Breast Surgery, Yamanashi Prefectural Central Hospital, Fujimi1-1-1, Kofu, Yamanashi, 400-8506, Japan

    Haruka Nakada, Masayuki Inoue, Kazushige Furuya, Hideki Watanabe, Kou Ikegame & Hiroshi Nakagomi

  2. First Department of Surgery, University of Yamanashi, Yamanashi, Japan

    Yuko Nakayama & Masato Ohmori

Authors
  1. Haruka Nakada
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  2. Masayuki Inoue
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  3. Kazushige Furuya
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  4. Hideki Watanabe
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  5. Kou Ikegame
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  6. Yuko Nakayama
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  7. Masato Ohmori
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  8. Hiroshi Nakagomi
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Correspondence to Hiroshi Nakagomi.

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The authors have declared no conflicts of interest.

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Nakada, H., Inoue, M., Furuya, K. et al. Fat necrosis after breast-conserving oncoplastic surgery. Breast Cancer 26, 125–130 (2019). https://doi.org/10.1007/s12282-018-0901-5

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  • DOI: https://doi.org/10.1007/s12282-018-0901-5

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