Journal time. This is the February 2016 Journal of Plastic and Reconstructive Surgery Journal. A big question we have when doing fat transfer to the breast is, “does it increase breast cancer risk?” It is a big question, and a study done in the lab indicated maybe stem cells did. But we know sometimes what we see in the lab in a test tube is not what we see in real life.
This study is a multi center study out of MD Anderson and the University of Michigan. “Lipofilling of the Breast Does not Increase the Risk of Recurrence of Breast Cancer: A Matched Controlled Study.”
Study:
- All patients who had segmental or total mastectomy between 1981-2014 who had lipofilling. (719 breasts)
- This was matched to similar patients who had recon without fat transfer. (670 breasts)
- Mean follow up was 60 months for lipofilling patients.
- Locoregional recurrence was found in 1.3% (2.4% of controls)
- Breast cancer did not develop in any cancer free breast that had fat transfer or not.
- Systemic recurrence was in 2.4% (3.6% for controls)
Conclusion:
There is no increase rate of breast cancer in local, regional, systemic, or second breast cancer. This supports the finding it is oncologically safe to do fat transfer to the breast.
What I think:
There has been talk about the safety of transferring fat (and the stem cells which naturally come with it) to the breast. The concern is the stem cells may reactivate sleeping tumor cells within the breast or activate a new primary breast cancer. Studies in the lab (as I mentioned above) have shown conflicting risks. Also there is concern there may be certain “at risk” groups for whom fat transfer is a high risk. This study included 33 patients at high risk who were BRCA positive, and they showed no increase in recurrence or new primaries.
I love this study. There were big numbers, and it was a controlled matched study. They looked at number of sessions of fat transfer, amounts, the cancer type/treatment/radiation. When doing reconstruction I have found fat to be invaluable for getting a better result. I have earlier blogs written about contraindications to doing fat transfer. This study will help allay some of those fears.
I do think you still need to think about fat transfer issues for the partial reconstruction. When patients have had lumpectomy with a resultant defect, fat transfer is an alluring choice. But fat transfer can still have issues with oil cysts, fat necrosis, and masses even in the best hands. While fat transfer may not cause cancer, it may cause other things which make evaluation of your breast more challenging. For total mastectomies, this is not a problem, as your breast tissue was removed with the mastectomy.