Secondary Logo

Journal Logo

Lipofilling in Breast Cancer Patients: From Surgical Technique to Oncologic Point of View

Petit, Jean Yves M.D.; Clough, Krishna M.D.; Sarfati, Isabelle M.D.; Lohsiriwat, Visnu M.D.; de Lorenzi, Francesca M.D., Ph.D.; Rietjens, Mario M.D.

Plastic and Reconstructive Surgery: November 2010 - Volume 126 - Issue 5 - p 262e-263e
doi: 10.1097/PRS.0b013e3181ef94a8
VIEWPOINTS
Free

Division of Plastic Surgery; European Institute of Oncology; Milan, Italy (Petit)

Paris Breast Center; Paris, France (Clough, Sarfati)

Division of Plastic Surgery; European Institute of Oncology; Milan, Italy (Lohsiriwat, de Lorenzi, Rietjens)

Correspondence to Dr. Petit, Division of Plastic Surgery, European Institute of Oncology, Via Ripamonti, 435, 20141 Milan, Italy, jean.petit@ieo.it

Back to Top | Article Outline

Sir:

An important question should be raised today concerning the safety of lipofilling in breast cancer patients. Indications for lipofilling are broadening extensively in aesthetic and reconstructive surgery. After breast cancer treatment, lipofilling is now used widely to improve the contour of the breast, both after breast conservation and after breast reconstruction. Tentative techniques of total breast reconstruction without prostheses or flaps have been performed and published.1–4

In 2008, the French Society of Plastic, Reconstructive and Aesthetic Surgery issued a recommendation to French plastic surgeons to postpone lipofilling in the breast with or without a history of breast cancer, unless it is performed under a prospective controlled protocol.5 In 2009, the American Society of Plastic Surgeons set up a fat graft task force to assess the safety and efficacy of autologous fat grafting.1 The task force conclusions mentioned that no publication studied emphasized an increasing risk of breast cancer recurrence or metastasis related to the lipofilling procedure. However, no study reached a high level of evidence as defined previously by the task force. Most studies were gathering small series, with short follow-up, poor definition of the cancer status of the patients, and no comparison with a control group.

Moreover, the preparation of the fat to be transferred varies widely. The selection of adult adipocytes by the Coleman technique using centrifugation to discard the other components of the aspirated specimen is the most frequently used. New approaches aiming at enhancing the proportion of adult stem cells are under study.3 Addition of growth factors to stimulate the survival of the adipocytes is also proposed by some authors.3 All of these techniques may promote the stimulation of angiogenesis, although cancer treatment research works on fighting against angiogenesis. Moreover, experimental animal studies demonstrate a stimulation of the cancer burden following lipofilling. A number of publications emphasize the endocrine, paracrine, and autocrine activity of the adipocytes. Adipokines can have the “tumor-stromal interaction” with breast parenchymal cell and stromal cells. For example, a high level of adiponectin seems to have an inhibitive effect on breast cancer, whereas leptin tends to stimulate cancer growth. No definitive conclusion can be drawn from “in vitro” studies, as cancer recurrence is concerned with breast cancer patients. However, the question of safety should be solved quickly because of reliable statistical controlled clinical studies. Today, no informed consent can be given to our patients stating that lipofilling does not stimulate fueling of dormant cancer cells or eventually induce new cancer cells. A multicenter study is required that gathers an important number of cases with a precise registration of the cancer status and that follows them prospectively for a sufficient number of years to reach reliable statistical results for comparison of the local recurrence rate with a matched controlled group.

Jean Yves Petit, M.D.

Division of Plastic Surgery

European Institute of Oncology

Milan, Italy

Krishna Clough, M.D.

Isabelle Sarfati, M.D.

Paris Breast Center

Paris, France

Visnu Lohsiriwat, M.D.

Francesca de Lorenzi, M.D., Ph.D.

Mario Rietjens, M.D.

Division of Plastic Surgery

European Institute of Oncology

Milan, Italy

Back to Top | Article Outline

REFERENCES

1. Gutowski KA, Baker SB, Coleman SR, et al. Current applications and safety of autologous fat grafts: A report of the ASPS fat graft task force. Plast Reconstr Surg. 2009;124:272–280.
2. Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: Safety and efficacy. Plast Reconstr Surg. 2007;119:775–785.
3. Chan CW, McCulley SJ, Macmillan RD. Autologous fat transfer: A review of the literature with a focus on breast cancer surgery. J Plast Reconstr Aesthet Surg. 2008;61:1438–1448.
4. Delay E, Gosset J, Toussoun G, Delaporte T, Delbaere M. Efficacy of lipomodelling for the management of sequelae of breast cancer conservative treatment (in French). Ann Chir Plast Esthet. 2008;53:153–168.
5. French Society of Plastic Reconstructive and Aesthetic Surgery [Société Française de Chirurgie Plastique Reconstructrice et Esthétique (SOFCPRE)]. Available at: http://www.plasticiens.org/. Accessed November 28, 2009.

Section Description

Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:

Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.

We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

©2010American Society of Plastic Surgeons