Does Fat Transfer to the Breast Affect Cancer Risk? A Summary of Recent Research
Fat transfer to the breast is considered safe after mastectomy by the American Society of Plastic Surgeons. Fat transfer is commonly done in breast reconstruction for volume and contour correction. Fat is taken from one part of the body by liposuction and re-injected into the breast area or between the skin and implant capsule in the case of breast reconstruction where there is also an implant. Plastic Surgeons accept fat grafting as standard of care in breast reconstruction and research shows no increase of cancer recurrence in post-mastectomy patients who have had fat transfer.
In a multicenter five year case-cohort study spanning 2006-2011, 3,271 patients who had mastectomies with immediate reconstructions at Memorial Sloan Kettering, MD Anderson Cancer Center, Alvin J. Siteman Cancer Center and the University of Chicago were studied (Myckatyn, 2017). The research focused on women at least 21 years old with invasive ductal carcinoma in situ who underwent reconstruction at the time of mastectomy. Women with prior breast cancer, cancer at stage IV, or inflammatory breast cancer were not included. Two hundred twenty-five patients or 6.9% of the study population had a recurrence of breast cancer. More advanced cancers i.e. stages III and IV, estrogen negative tumors, and HER2/ negative tumors were associated with higher breast cancer recurrence but not fat grafting. Fat transfer did not increase the risk of breast cancer recurrence in any patients.
In 2016, plastic surgeons at MD Anderson investigated their records for patients between 1981 and 2014 who underwent reconstruction after segmental or total mastectomy and found lipofilling did not increase the risk of breast cancer (Kronowitz, 2016). They compared 670 breasts that were reconstructed without lipofilling and 1,024 consecutive breasts reconstructed with lipofilling. Of the lipofilled breasts, 719 had partial or total mastectomy for cancer and 305 cancer-free breasts had mastectomy for risk reduction, either the cancer-free breast had a genetic predisposition-BRCA or cancer in the other breast. The follow-up times were longest for the cancer-free breasts 73 months, longer for the lipofilled 60 months, and 44 months for non-lipofilled breasts. Breast cancer did not develop in the lipofilled, healthy breasts. The 5-year local (chest area) recurrence rates were 1.3% (9 of 719) for lipofilling cases and 2.4% (16 of 670) for non-lipofilled patients. Distant metastasis rates were 2.4% (17 of 1064) for lipofilled breasts and 3.6% (24 of 670) for non-lipofilled breasts. Neither the quantity of fat injected nor the number of times fat was injected were associated with higher recurrence. Hormonal therapy was associated with a higher chest wall recurrence in the lipofilling cases. There was no increase in chest wall recurrence, metastasis, or breast cancer in healthy breasts associated with fat transfer to the breast. In other words, this research showed that in more than a thousand breasts, fat transfer did not increase risk of cancer.
Another study carried out in Nottingham, England in 2015 found no increased cancer risk associated with fat grafting in women treated for breast cancer (Gale, 2015). Two hundred and eleven women underwent fat transfer after treatment of breast cancer by mastectomy 83% and lumpectomy 17% between 1977 and 2013. These cases were matched with a control group based on age, type of surgery, histology, estrogen receptor status, and disease-free interval by time of fat grafting. Follow up time was on average 88 months after primary cancer surgery and 32 months after fat grafting. There was no increase in local (0.95% versus 1.90%, p=0.33), regional (0.95% versus 0, p=0.16), and systemic recurrences (3.32% versus 2.61%, p=0.65) in patient patients receiving fat grafting compared to a control group. So, in 211 Nottingham patients, fat grafting after mastectomy or breast conserving therapy did not increase breast cancer recurrence.
*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.
Gale, K. L. (2015). A Case-Controlled Study of the Oncologic Safety of Fat Grafting. Plast Reconstr Surg, 135(5), 1263-1275.
Kronowitz, S. J. (2016). Lipofilling of the Breast Does Not Increase the Risk of Recurrence of Breast Cancer: A Matched Controlled Study. Plast Reconstr Surg, 137, 385-393.
Myckatyn, T. M. (2017). Cancer Risk after Fat Transfer: A Multicenter Case-Cohort Study. Plast. Reconstr. Surg., 139(1), 11-18.