Background: Fat transfer is an increasingly popular method for refining postmastectomy breast reconstructions. However, concern persists that fat transfer may promote disease recurrence. Adipocytes are derived from adipose-derived stem cells and express adipocytokines that can facilitate active breast cancer cells in laboratory models. The authors sought to evaluate the association between fat transfer to the reconstructed breast and cancer recurrence in patients diagnosed with local or regional invasive breast cancers.
Methods: A multicenter, case-cohort study was performed. Eligible patients from four centers (Memorial Sloan Kettering, M. D. Anderson Cancer Center, Alvin J. Siteman Cancer Center, and the University of Chicago) were identified by each site’s institutional tumor registry or cancer data warehouse. Eligibility criteria were as follows: mastectomy with immediate breast reconstruction between 2006 and 2011, age older than 21 years, female sex, and incident diagnosis of invasive ductal carcinoma (stage I, II, or III). Cases consisted of all recurrences during the study period, and controls consisted of a 30 percent random sample of the study population. Cox proportional hazards regression was used to evaluate for association between fat transfer and time to recurrence in bivariate and multivariate models.
Results: The time to disease recurrence unadjusted hazard ratio for fat transfer was 0.99 (95 percent CI, 0.56 to 1.7). After adjustment for age, body mass index, stage, HER2/Neu receptor status, and estrogen receptor status, the hazard ratio was 0.97 (95 percent CI, 0.54 to 1.8).
Conclusion: In this population of breast cancer patients who had mastectomy with immediate reconstruction, fat transfer was not associated with a higher risk of cancer recurrence.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
St. Louis, Mo.; Chapel Hill, N.C.; New York, N.Y.; Houston, Texas; Chicago and Arlington Heights, Ill.; Boston, Mass.; and Columbus, Ohio
From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine in Saint Louis, and the Alvin J. Siteman Cancer Center; the Division of Plastic and Reconstructive Surgery, the Department of Biostatistics, the Department of Epidemiology, Gillings School of Global Public Health, the Lineberger Comprehensive Cancer Center, and the Division of Surgical Oncology, Department of Surgery, University of North Carolina; the Department of Surgery, Memorial Sloan Kettering Cancer Center; the Department of Plastic Surgery, M. D. Anderson Cancer Center; the Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences, University of Chicago; The Plastic Surgery Foundation; the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School; the Department of Epidemiology, Harvard T. H. Chan School of Public Health; and Plastic and Reconstructive Surgery, Health Services Management and Policy, Ohio State University.
Received for publication April 4, 2016; accepted August 4, 2016.
Disclosure: The authors have no financial interest to declare in relation to the content of this article.
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This work was supported by THE PLASTIC SURGERY FOUNDATION.
Terence M. Myckatyn, M.D., Plastic and Reconstructive Surgery, Washington University School of Medicine in St. Louis, Saint Louis, Mo. 63110, firstname.lastname@example.org