Autologous Fat Grafting to the Breast: A Review of Safety and Oncological Outcomes
Krishna S. Vyas, MD, PhD, MHS1, Chris Howell, BS2, Henry C. Vasconez, MD2.
1Mayo Clinic, Rochester, MN, USA, 2University of Kentucky, Lexington, KY, USA.
PURPOSE: Autologous fat grafting has been widely used for more than two decades during breast reconstruction for postmastectomy patients. However, few studies evaluate clinical outcomes in this patient population. The purpose of this study was to assess complications, radiographic changes and locoregional cancer recurrence outcomes in patients undergoing autologous fat grafting after breast reconstruction in postmastectomy patients.
METHODS: We retrospectively reviewed the records of consecutive postmastectomy patients who underwent autologous fat grafting after breast reconstruction at a university center over a 10-year period. Patients with at least 3 months of follow-up were included. Medical records were reviewed for demographics, operative details, complications, incidence of palpable masses, and/or suspicious breast imaging findings, and locoregional cancer recurrence. Descriptive statistics were generated.
RESULTS: The records of 124 patients undergoing lipofilling procedures from January 2006 to January 2016 were reviewed. Their ages ranged from 23 to 79 years (mean, 45.77 years). Fat grafts were harvested, processed, and injected using the Coleman technique. The mean number of fat grafting procedures was 1.50 (range, 1-6) per 85 breast, receiving 97.2 mL of autologous adipose on average during each session. The most common indication for reconstruction in this study was found to be for aesthetic correction following mastectomy (90.6 % of patients). Fat grafting was most commonly used as an adjunctive therapy following initial implant (54.9% of patients) and flap (43.4% of patients) reconstruction. The time from first oncological surgery to fat grafting occurred after a mean of 27.51 months and median of 14 months. Following the completion of fat grafting, patients were followed by a plastic surgeon for an average of 1 month. Twenty-six complications were found to have occurred, resulting in a complication rate of 21.3% in this population of patients. The most commonly reported complications were liponecrosis (19.2% of complications) and infection (15.3% of complications). During oncologic follow up, six patients were reported to have experienced breast cancer recurrence following autologous fat grafting for reconstruction resulting in a recurrence rate of 4.8%. Additionally, of the 59 patients with reported radiologic follow up, seven patients exhibited radiological abnormalities in the post-operative period (11.9%).
CONCLUSIONS: In this population of breast cancer patients who had mastectomy with reconstruction, fat transfer was not associated with a higher risk of cancer recurrence. Based on these preliminary findings, autologous fat grafting appears to be a relatively safe procedure for refinement of the reconstructed breast in postmastectomy patients.
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