Background: Although many plastic surgeons perform autologous fat grafting (lipofilling) for breast reconstruction after oncologic surgery, it has not been established whether postoncologic lipofilling increases the risk of breast cancer recurrence. The authors assessed the risk of locoregional and systemic recurrence in patients who underwent lipofilling for breast reconstruction.
Methods: The authors identified all patients who underwent segmental or total mastectomy for breast cancer (719 breasts) (i.e., cases) or breast cancer risk reduction or benign disease (305 cancer-free breasts) followed by breast reconstruction with lipofilling as an adjunct or primary procedure between June of 1981 and February of 2014. They also then identified matched patients with breast cancer treated with segmental or total mastectomy followed by reconstruction without lipofilling (670 breasts) (i.e., controls). The probability of locoregional recurrence was estimated by the Kaplan-Meier method.
Results: Mean follow-up times after mastectomy were 60 months for cases, 44 months for controls, and 73 months for cancer-free breasts. Locoregional recurrence was observed in 1.3 percent of cases (nine of 719 breasts) and 2.4 percent of controls (16 of 670 breasts). Breast cancer did not develop in any cancer-free breast. The cumulative 5-year locoregional recurrence rates were 1.6 percent and 4.1 percent for cases and controls, respectively. Systemic recurrence occurred in 2.4 percent of cases and 3.6 percent of controls (p = 0.514). There was no primary breast cancer in healthy breasts reconstructed with lipofilling.
Conclusions: The study results showed no increase in locoregional recurrence, systemic recurrence, or second breast cancer. These findings support the oncologic safety of lipofilling in breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
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Houston, Texas; and Ann Arbor, Mich.
From the Departments of Plastic and Reconstructive Surgery, Surgical Oncology, Radiation Oncology, and Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center; and the Department of Breast Radiation Oncology, University of Michigan.
Received for publication February 23, 2015; accepted September 15, 2015
Disclosure: The authors have no financial interests to declare in relation to the content of this article.
Steven J. Kronowitz, M.D., Kronowitz Plastic Surgery, PLLC, 1200 Binz, Suite 380, Houston, Texas 77004, firstname.lastname@example.org