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Can patients receiving breast conserving surgery (lumpectomy), have fat transfer?

Posted March 31, 2017 in Breast Reconstruction, Fat Transfer

Can patients receiving breast conserving surgery (lumpectomy), have fat transfer? *

Dr. Sarah Mess

Partial mastectomy and lumpectomy leave behind breast tissue but remove the cancer and are termed breast conserving therapy (BCT). Breast conserving therapy often results in the operated breast being smaller or having a dent.  Fat transfer is a better modality than breast implant to fix the size difference or dents, especially since BCT often includes radiation therapy which can lead to hardened breast implants or capsular contracture.  Theoretically BCT patients would be most vulnerable to breast cancer recurrence if fat transfer could stimulate breast cancer.  While breast conservation therapy patients should discuss with their oncologic doctor: tumor type, margins, radiation therapy and time lapse prior to fat transfer to the breast, studies involving partial mastectomy or lumpectomy and fat transfer show there is no increased recurrence when (a) the tumor removal margins are clear, (b) the fat transfer is delayed until least4 years after the tumor removal.

A 2016 study of 73 patients in the Czech Republic showed no increase in breast cancer recurrence after BCT and fat transfer (Mestak, 2016).   Fat grafting was performed about 4 years after BCT. Only 2 of 32 (6.25%) patients who underwent BCT and fat grafting had recurrences. In a control group with patients with similar cancer stages, tumor grades, hormone types, and follow up times who had BCT and no fat transfer, recurrence was 2 of 41 (4.88%). In other words, there was no significant difference between patients who did or did not have fat transfer after lumpectomy  when it came to cancer recurrence rates.

A multicenter study in France and Italy from 2000-2010 of 646 lipofilling procedures in 512 patients demonstrated a low complication rate and no interference with radiologic follow-up (Petit, 2011).  Compared to a database from the European Institute of Oncology, the study’s mastectomy-lipofilled patients had no difference in recurrence. However, their lumpectomy-lipofilled patients had 2.07% recurrence compared to 0.4% recurrence in 2784 database patients. The average time between lumpectomy and lipofilling was 3 years.  Another study by Petit in France showed only 8 of the 321 lipofilled patients had recurrence while 19 of 642 controls had breast cancer recurrence which is not a significant difference  (Petit, 2012).  The average time from lumpectomy and lipofilling was 2 years. Breakout analysis of 37 lumpectomy patients with high grade intraepithelial cancer suggested that fat transfer may be associated with higher chest wall recurrence of breast cancer compared to their study controls.  However, the 2.5% over two years recurrence rate was in line with the 1.5% per year recurrence rate of intraepithelial cancer found in review of the literature.  The higher rate could be a sampling error of the control population.   The presence and type of radiation therapy after lumpectomy was not discussed in the article and could be relevant to recurrence. Most breast cancer recurrences occur 5 years after all breast conserving surgery patients.  More studies with longer follow ups are needed to study the safety of breast conserving therapy and fat transfer reconstruction.  So, to correct asymmetry or contour deformity after breast conserving therapy should have clear margins, appropriate treatment, and a minimum of 4 years cancer-free prior to fat transfer.

* Please cite Mess, S. (2017). Can patients receiving breast conserving therapy (lumpectomy), have fat transfer? *Blogpost. Downloaded from www.sarahmessmd.com on date of download when quoting or reproducing this article or portions of this article.

References

Mestak, O. (2016). Evaluation of Oncological Safety of Fat Grafting After Breast-Conserving Therapy: A Prospective Study. Ann Surg Oncol, 23, 776-781.

Petit, J. Y. (2011). The Oncologic Outcome and Immediate Surgical Complications of Lipofilling in Breast Cancer Patients: A Multicenter Study-Milan-Paris-Lyon Experience of 646 Lipofilling Procedures. Plast Reconstr Surg, 128(2), 341-346.

Petit, J. Y. (2012). Locoregional recurrence risk after lipofilling in breast cancer patients. Ann Ocol, 23, 582-588.

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