Oncological safety of breast cancer patients undergoing free-flap reconstruction and lipofilling

Masià, Jaume; Bordoni, Daniele; Pons, Gemma; Liuzza, Claudia; Castagnetti, Fabio; Falco, Giuseppe

doi:10.1016/j.ejso.2015.02.008

Cited by 24 publications

(24 citation statements)

References 21 publications

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“…Multiple studies have indicated that breast imaging and cancer screening can still be effectively managed following fat grafting 9, 29–31 . Although research on breast cancer risk and fat transfer is ongoing, recent reports have failed to demonstrate an association between breast cancer recurrence with fat grafting 9,10,32 .…”

Section: Discussionmentioning

confidence: 99%

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Bennett

Kim

et al. 2017

JAMA Surg

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Importance Fat grafting has proven to be a useful adjunct to breast reconstruction for the treatment of contour irregularities and volume deficits, but the proposed FDA regulations may severely limit the ability of plastic surgeons to continue its use in this clinical context. Objective To determine if fat grafting has an effect on patient-reported outcomes (PROs) in breast reconstruction patients. Design Longitudinal, multicenter, prospective cohort study conducted between February 2012 and July 2016. Setting Conducted at the 11 study sites associated with the Mastectomy Reconstruction Outcomes Consortium (MROC) study. Participants Eligible patients included women 18 years and older presenting for breast reconstruction following mastectomy with at least two years of follow-up. All primary procedure types (implant- and flap-based) were eligible. Patients were excluded if they had not completed breast mound reconstruction by one year after mastectomy. Interventions Fat grafting as an adjunct to breast reconstruction. Main outcomes and measures Primary end points were patient-reported outcome measures as assessed by the validated BREAST-Q, with higher scores indicating better health-related quality of life. Survey subscales included breast satisfaction, as well as psychosocial, physical, and sexual well-being. Patient-reported outcomes were compared between fat grafted and non-fat grafted patients. Results A total of 2,048 women were included, with 165 undergoing fat grafting between years one and two. One year postoperatively, patients who later underwent fat grafting reported significantly lower breast satisfaction (adjusted mean difference (AMD) = −4.74, CI −8.21 to −1.28, p=0.008), psychosocial well-being (AMD = −3.87, CI −7.33 to −0.40, p=0.029), and sexual well-being (AMD = −5.59, CI −9.70 to −1.47, p=0.008), compared to those who did not receive subsequent fat grafting. Following fat grafting, the fat grafted cohort reported similar breast satisfaction (AMD = −0.68, CI −4.42 to 3.06, p=0.719), psychosocial well-being (AMD = −0.59, CI −3.92 to 2.74, p=0.728), and sexual well-being (AMD = −2.94, CI −7.01 to 1.12, p=0.154) at two years postoperatively. Conclusions and relevance Fat grafting improves breast satisfaction, psychosocial well-being, and sexual well-being in breast reconstruction patients.

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Section: Discussionmentioning

confidence: 99%

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Bennett

Kim

et al. 2017

JAMA Surg

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“…Gale et al 32 Krastev Fertsch et al 31 Gale et al 32 26 Kim et al 40 Kronowitz et al 42 Laporta et al 44 Masia et al 47 Mestak et al 50 Pinell-White et al 61 Seth et al 68 Stumpf et al 71 Mestak et al 49 Stumpf et al 71 RE model (I 2 = 41·00%)…”

Section: Re Modelmentioning

confidence: 99%

“…Cohen et al 26 Kim et al 40 Kronowitz et al 42 Laporta et al 44 Masia et al 47 Pinell-White et al 61 Seth et al 68…”

Section: Mastectomymentioning

confidence: 99%

“…To place the measured pooled effect estimate in context for the general breast cancer population, it was compared with the reported incidence rates in large historical cohorts. Zhu et al 74 Tissiani and Alonso 72 Stumpf et al 71 Silva-Vergara et al 70 Semprini et al 67 Seth et al 68 Rigotti et al 64 Riggio et al 63 Pinell-White et al 61 Petit et al 56 Noor et al 54 Moltó Garciá et al 53 Missana and Germain 52 Mirzabeigi et al 50 Mestak et al 49 Masia et al 47 Manconi et al 46 Longo et al 45…”

Section: Re Modelmentioning

confidence: 99%

“…Khan et al 39 Ihrai et al 36 Helme et al 33 Gale et al 32 Constantini et al 27 Brown et al 24 Beck et al 19 Bayti et al 18 Amar et al 17 Zhu et al 74 Tissiani and Alonso 72 Silva-Vergara et al 70 Seth et al 68 Rigotti et al 64 Riggio et al 63 Pinell-White et al 61 Petit et al 56 Noor et al 54 Missana et al 51 Masia et al 47 Manconi et al 46 Longo et al 45 Kronowitz et al 42…”

Section: Krastev Et Al (Unpublished)mentioning

confidence: 99%

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Meta-analysis of the oncological safety of autologous fat transfer after breast cancer

Krastev

Schop

Hommes

et al. 2018

British Journal of Surgery

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Long-term Follow-up of Autologous Fat Transfer vs Conventional Breast Reconstruction and Association With Cancer Relapse in Patients With Breast Cancer

et al. 2019

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IMPORTANCE Autologous fat transfer (AFT or fat grafting) has become an invaluable tool for the correction of disfiguring deformities after breast cancer surgery. However, clinical and animal studies have shown conflicting results regarding its oncologic safety. OBJECTIVE To determine whether exposure to AFT vs conventional breast reconstruction is associated with increased rates of cancer relapse in patients with breast cancer. DESIGN, SETTING, AND PARTICIPANTS This matched cohort study involved retrospective medical record review to identify all patients in a local patient database receiving AFT between 2006 and 2014. Each AFT case was matched with a nonexposed control patient with similar baseline characteristics. The mean (SD) follow-up of patients receiving AFT was 9.3 (4.9) years including 5.0 (1.7) years following AFT. Control patients were followed up for a mean (SD) of 8.6 (1.8) years from the primary surgery. Patients were identified through the local patient database of the Tergooi Hospital in Hilversum, the Netherlands. A total of 287 patients with breast cancer (300 affected breasts) who received AFT for breast reconstruction after cancer were included in the intervention group. Each AFT case was matched with a respective control patient based on age, type of oncologic surgery, tumor invasiveness, and disease stage. In addition, individual AFT-control pairs were selected to have the same locoregional recurrence-free interval at baseline. Data were analyzed between 2016 and 2017. EXPOSURES Reconstruction with AFT vs conventional breast reconstruction or none. MAIN OUTCOMES AND MEASURES Primary end points were the cumulative incidences of oncologic events in AFT and control patients and their respective hazard ratios. RESULTS Of the 587 total patients, all were women and the mean age was 48.1 years for the patients undergoing AFT and 49.4 years for the control patients. Eight locoregional recurrences were observed in the treatment group (287 patients) and 11 among the control group (300 patients), leading to an unadjusted hazard ratio of 0.63 (95% CI, 0.25-1.60; P = .33). No increased locoregional recurrence rates were seen in relevant subgroups based on the type of oncological surgery, tumor invasiveness, or pathological stage. In addition, no increased risks with AFT were detected with respect to distant recurrences or breast cancer-specific mortality. CONCLUSIONS AND RELEVANCE No significant differences in the locoregional recurrence rates between the AFT and control groups were observed after 5 years of follow-up. These findings confirm the results of previous studies; therefore, clinical evidence suggesting that AFT is associated with increased risk for cancer relapse is still lacking.

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Oncological safety of breast cancer patients undergoing free-flap reconstruction and lipofilling

Cited by 24 publications

References 21 publications

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Meta-analysis of the oncological safety of autologous fat transfer after breast cancer

Long-term Follow-up of Autologous Fat Transfer vs Conventional Breast Reconstruction and Association With Cancer Relapse in Patients With Breast Cancer

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