Does lipofilling after oncologic breast surgery increase the amount of suspicious imaging and required biopsies?—A systematic meta‐analysis

Abstract

Objective:The aim of our systematic meta-analysis was to find out if lipofilling to the breast alters follow-up imaging procedures and leads to an increased number of biopsies because of suspicious findings. Methods:We conducted a systematic meta-analysis of the literature including all prospective and retrospective studies focusing on imaging outcomes in patients with a history of breast cancer who have received one or more lipofilling procedures after oncologic surgery to the breast.Results: Twelve studies met the inclusion criteria, comprising 1711 patients and at least 2261 lipofilling procedures. 564 patients (33%) were followed up only with ultrasound, 735 patients (43%) only received mammography, 273 (16%) had a combination of ultrasound, mammography and MRI, and 37 patients (2.1%) were followed up via ultrasound and mammography. A collective of 102 patients making up a matchedcohort study received ultrasound, mammography, MRI, and PET/CT, while only 51 of them made up the investigation group who had autologous fat grafting (3%). Biopsy rates were 1%-24% with a medium of 6.5% over all groups. Medium follow-up was 18.8 months (range 6-50 months). The rate of local oncologic events among the patients with lipofilling procedures detected during the study periods was 0.7%. Conclusion:Lipofilling to the breast after oncologic operations appears to be a safe procedure with overall low biopsy and local recurrence rate. Suspicious imaging occurs in most cases out of physiologic remodeling and inflammation processes at the operation site and needs to be distinguished from malignant focusses. The amount of required biopsies stands in relation to the used imaging method and the time to follow-up. K E Y W O R D S lipofilling, autologous fat transfer, breast cancer, surveillance, mammography 1 | INTRODUC TI ON Over the last century, fat grafting has become increasingly important in reconstructive breast surgery and mastectomy for oncologic and cosmetic purposes. 1 The technique developed by Coleman thirty years ago has become the gold standard lipofilling procedure. 2-6 Manual lipoaspiration under low pressure from body regions as saddle bags or abdomen, centrifugation, and reinjection

Breast Autologous Fat Transfer Entirely Under Tumescent Anesthesia: Safety and Efficacy

“…After the publication of numerous studies showing no oncologic risk associated with autologous fat transfer to the breast, 2–10 Kouri and others published data showing that preoperative use of external expansion could reliably increase the successfully grafted volume from approximately 50 mLs to more than 200 mLs. 11–15 All previous studies have published the use of autologous fat transfer to the breast as a procedure under general anesthesia, using solutions containing epinephrine to control bleeding in the donor areas.…”

“…Further meta-analyses have confirmed no increase in the incidence of radiographic procedures or biopsies after postoncologic fat grafting. 10 The prior use of external expansion to the breast has been described in the literature as a tool to allow reliable grafting of more than 200 mLs of autologous fat under general anesthesia. [11][12][13][14][15] The purpose of this pilot study was to determine whether this technique could be adapted to be undertaken safely and effectively entirely under tumescent anesthesia.…”

“…Further meta-analyses have confirmed no increase in the incidence of radiographic procedures or biopsies after postoncologic fat grafting. 10 …”

Aesthetic breast surgery: putting in context—a narrative review

“…There may be a need for biopsy to confirm the diagnosis beyond doubt in some situations. Safety of lipofilling has been questioned with regards to risk of breast cancer; however there is no evidence to support that in clinical studies (60)(61)(62).…”

The prognosis outcomes of autologous fat transfer for breast reconstruction after breast cancer surgery: a systematic review and meta-analysis of cohort studies

“…According to the American Society of Plastic Surgeons, 6 2 % o f p l a s t i c s u r g e o n s a p p l i e d A F T i n b r e a s t reconstruction in 2018, predominately for restoring volume defects in the upper quadrant of the breast to improve the aesthetic results (2). Considering the enhancement of breast contour and improvement of aesthetic outcomes, most female breast cancer patients are willing to receive AFT surgery (3,4). Although thousands of patients undergo AFT every year, there is still some concern over the oncological safety of AFT for breast reconstruction following breast cancer surgery.…”