Fat grafts ‘safe’ following breast reconstruction

By MedWire Reporters

Autologous fat grafting following breast reconstruction does not increase the long-term risk for tumor recurrence, US research shows.

"Autologous fat grafting remains an attractive, and flexible, tool for optimizing aesthetic outcomes during breast reconstruction, with an associated low risk of complications," say Neil Fine (Northwestern University, Chicago, Illinois) and colleagues.

The injection of fat offers physicians several advantages in the revision of the reconstructed breast, but it remains controversial.

Grafting small amounts of autologous fat can correct volume defects and breast contour deformities, particularly following unilateral reconstruction where symmetry is critical to a successful outcome.

In addition, fat grafting provides a natural consistency and texture to the reconstructed breast.

Despite the benefits, the "oncologic risks of injecting fat into a post-breast cancer field remain unclear," note the researchers.

Some experimental studies have suggested that adipocytes might directly stimulate tumor growth and progression, particularly when near residual breast cancer cells.

Published in Plastic Reconstructive Surgery, the retrospective review included 886 consecutive patients undergoing mastectomy at one institution between 1998 and 2008.

In total, 1202 breasts underwent reconstruction, including 90 breasts that were injected with autologous fat an average of 18.3 months following reconstruction.

The primary fat harvesting sites were the abdominal, hip, and lateral flank regions. At baseline, there were no significant differences in patient demographics or operative characteristics between the fat grafting and nonfat grafting patients.

Stratifying patients based on breast cancer stage, there was no observed difference in cancer burden between nonfat grafting and fat grafting breasts.

After a mean follow-up period of 2 years after the fat-grafting procedure, there were no recurrences in patients who underwent autologous fat grafting, while the local recurrence rate was 1.5% in women who did not undergo fat grafting.

Similarly, 100% of patients who underwent fat grafting postreconstruction were alive during follow up compared with 95.5% of patients treated without fat grafting, although this difference was not significant.

Still, the definitive impact of autologous fat grafting remains to be determined, and continued research in prospective studies is "needed to establish fat grafting as a safe and routine technique for revisional breast surgery," state the researchers.

Overall, there was one postoperative complication associated with fat grafting, a case of local fat necrosis at the site of injection. The case was managed with conservative medical therapy.

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