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Rijkx MEP, Bernardi E, Schop SJ, Heuts EM, Lobbes MBI, Hommes JE, de Grzymala AP, van Nijnatten TJA. Radiologic findings in women after Autologous Fat Transfer (AFT) based breast reconstruction: A Systematic Review. JPRAS Open 2024; 42:113-132. [PMID: 39308743 PMCID: PMC11416601 DOI: 10.1016/j.jpra.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 08/11/2024] [Indexed: 09/25/2024] Open
Abstract
Purpose Autologous fat transfer (AFT) is increasingly used in breast reconstructive surgery. Due to post-surgical changes, in breast imaging after AFT, it can be challenging to differentiate between benign and suspicious findings. This systematic review aimed to present an overview of the literature on breast imaging after AFT-based breast reconstruction. The descriptive radiologic findings focus on different breast imaging modalities (i.e., mammography (MG), ultrasound (US), and breast magnetic resonance imaging (MRI)) to provide an overview of the most commonly reported benign and suspicious findings. Results The literature search yielded 20 studies from 2006-2022 that reported AFT-based breast reconstructions and included the radiologic evaluation of the included breast imaging modalities. Only six of the 20 included studies provided qualitative descriptions of radiologic findings. Fat necrosis was most frequently reported. On MG, fat necrosis was described in a variety of stages such as oil cyst or cytosteatonecrosis with or without calcifications. On US, it was described as a nonvascular hypo- or anechoic mass, and on breast MRI, it was most frequently reported as hypointense homogenous architectural distortion. Additional biopsies to differentiate between benign and malignant findings after AFT-based breast reconstruction were reported in 13 of the 20 studies. Among all included studies in the current review, a total of 34 of 137 biopsies were considered malignant (24.8%). Conclusion Qualitative descriptions of the reported radiologic findings after AFT for breast reconstruction were limited. Additional biopsies can be considered to differentiate between benign and suspicious findings. More experience and research are necessary to improve the interpretation of breast imaging after AFT-based breast reconstructions.
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Affiliation(s)
- M E P Rijkx
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - E Bernardi
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S J Schop
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - E M Heuts
- Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M B I Lobbes
- Department of Radiology, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - J E Hommes
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A Piatkowski de Grzymala
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - T J A van Nijnatten
- Department of Radiology, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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Lo Torto F, Patanè L, Abbaticchio D, Pagnotta A, Ribuffo D. Autologous Fat Grafting (AFG): A Systematic Review to Evaluate Oncological Safety in Breast Cancer Patients. J Clin Med 2024; 13:4369. [PMID: 39124636 PMCID: PMC11313166 DOI: 10.3390/jcm13154369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/18/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Autologous fat grafting (AFG) has emerged as a useful technique in breast reconstruction. Utilizing a patient's own fat from areas like the abdomen or thighs, AFG serves various reconstruction needs. Nevertheless, the oncological safety of AFG in breast cancer patients has become a contentious issue. Concerns about its influence on cancer recurrence and detention have led to significant clinical debate and the need for thorough investigation. Methods: To determine the impact of autologous fat grafting (AFG) on loco-regional recurrence (LRR) in breast cancer survivors undergoing reconstruction, a comprehensive search of databases including PubMed, Medline, Web of Science, and Cochrane libraries was conducted from November 2023 through March 2024. This search adhered to the PRISMA guidelines and aimed to identify all the relevant studies on AFG in the context of breast reconstruction post cancer treatment. A meta-analysis was performed. Results: Out of the studies reviewed, 40 met the inclusion criteria, with a total patient cohort of 14,078. The analysis revealed that AFG had no significant association with increased rates of LRR. Conclusions: According to the available literature, AFG is a safe reconstructive option for breast cancer patients and does not increase the risk of loco-regional recurrence. Nevertheless, further well-structured long-term prospective studies are required, since heterogeneity of available studies is high and requires standardization.
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Affiliation(s)
- Federico Lo Torto
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | - Luca Patanè
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | - Donato Abbaticchio
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessia Pagnotta
- Hand and Microsurgery Unit of the Jewish Hospital of Rome, 00186 Rome, Italy
| | - Diego Ribuffo
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy
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Al Qurashi AA, Shah Mardan QNM, Alzahrani IA, AlAlwan AQ, Bafail A, Alaa Adeen AM, Albahrani A, Aledwani BN, Halawani IR, AlBattal NZ, Mrad MA. Efficacy of Exclusive Fat Grafting for Breast Reconstruction: An Updated Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-03978-3. [PMID: 38772941 DOI: 10.1007/s00266-024-03978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Exclusive fat grafting is an alternative method to implant- or flap- based reconstruction techniques following mastectomies or breast conservation therapies. Its efficacy has been explored before but new data has come to light, resulting in previous results becoming outdated. Concerns have also been raised about the oncological safety of this procedure which must be evaluated alongside the efficacy to gain a comprehensive understanding of the merits of this alternative technique. METHODS We queried the PubMed electronic database from its inception until August 2023 for studies evaluating the efficacy and oncological safety of exclusive fat grafting breast reconstruction following cancer-related mastectomy or breast conservation therapy. Results of the analysis were pooled and presented as means or valid proportions. Results of the analysis were pooled using a random-effects model and presented with 95% confidence intervals (95% CIs) where appropriate. RESULTS 41 studies were included in our analysis. Pooled results show that on average, 1.7 sessions of exclusive fat grafting were required to complete reconstruction in Breast Conservation Therapy (BCT) patients, with an average volume of 114.2 ml being injected. For mastectomy patients with irradiated breasts, 4.7 sessions were needed on average with 556.8 ml being required to complete reconstruction, compared to their non-irradiated Counterparts requiring only 2.6 sessions and 207.2 ml to complete reconstruction. Oncological recurrence events were found in 29/583 non-irradiated mastectomy patients (p = 0.014) and in 41/517 BCT patients (p = 0.301) CONCLUSION: Exclusive fat grafting is an oncologically safe and reasonably efficacious alternative to more common methods of breast reconstruction. More data is needed to fully characterize the oncological safety of this procedure in irradiated and non-irradiated mastectomy patients. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Qutaiba N M Shah Mardan
- Plastic and Reconstructive Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdullah Q AlAlwan
- Department of Plastic and Reconstructive Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Anas Bafail
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulqader Murad Alaa Adeen
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulaziz Albahrani
- Department of Plastic and Reconstructive Surgery, King Fahad Hospital, Al Hofuf, Saudi Arabia
| | - Batoul Najeeb Aledwani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Nouf Z AlBattal
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed Amir Mrad
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, 11211, Riyadh, Saudi Arabia.
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Seth I, Bulloch G, Gibson D, Chow O, Seth N, Mann GB, Hunter-Smith DJ, Rozen WM. Autologous Fat Grafting in Breast Augmentation: A Systematic Review Highlighting the Need for Clinical Caution. Plast Reconstr Surg 2024; 153:527e-538e. [PMID: 37166041 DOI: 10.1097/prs.0000000000010614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Autologous fat grafting (AFG) is a breast augmentation method for treating volume and contour abnormalities. This systematic review aims to summarize complications, radiologic safety, volume retention, and patient satisfaction associated with AFG. METHODS The PubMed, Embase, Google Scholar, Cochrane Central Register of Controlled Trials, Wiley library, clinical key/Elsevier, and EBSCO databases were searched for relevant studies from January of 2009 to March of 2022. Articles describing AFG for breast augmentation were selected based on predetermined inclusion and exclusion criteria. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to, and the study was registered on the International Prospective Register of Systematic Reviews. The Risk of Bias in Nonrandomized Studies of Interventions assessment was used to assess the quality of studies and the risk of bias was measured using the Cochrane Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions. RESULTS A total of 35 studies comprising 3757 women were included. The average follow-up duration was 24.5 months (range, 1 to 372 months). The overall complication rate was 27.8%, with fat necrosis making up 43.7% of all complications. Average fat volume injected was 300 mL (range, 134 to 610 mL), and average volume retention was 58% (range, 44% to 83%). Volume retention was greater with supplementation of fat with platelet-rich plasma and stromal vascular fraction. The most common radiologic changes were fat necrosis (9.4%) and calcification (1.2%). After 1 year of follow-up, patient satisfaction was, on average, 92% (range, 83.2% to 97.5%). The included studies were of good quality and consisted of a moderate risk of bias. CONCLUSIONS AFG was associated with an overall complication rate of 27.8%. Additional supplementation of fat with platelet-rich plasma and stromal vascular fraction may improve graft survival. Despite poor volume retention being a persistent drawback, patient satisfaction remains high.
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Affiliation(s)
- Ishith Seth
- From the Department of Plastic Surgery, Bendigo Health
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre
| | | | - Damien Gibson
- Department of Surgery, Macquarie University Hospital
| | | | - Nimish Seth
- Department of Surgery, University of Melbourne
| | | | - David J Hunter-Smith
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre
| | - Warren M Rozen
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre
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Piatkowski AA, Wederfoort JLM, Hommes JE, Schop SSJ, Krastev TK, van Kuijk SMJ, van der Hulst RRWJ. Effect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer: A Randomized Clinical Trial. JAMA Surg 2023; 158:456-464. [PMID: 36857058 PMCID: PMC9979010 DOI: 10.1001/jamasurg.2022.7625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/15/2022] [Indexed: 03/02/2023]
Abstract
Importance There is a need for a new, less invasive breast reconstruction option for patients who undergo mastectomy in their breast cancer treatment. Objective To investigate quality of life (QoL) among patients undergoing a new breast reconstruction technique, autologous fat transfer (AFT), compared with that among patients undergoing implant-based reconstruction (IBR). Design, Setting, and Participants The BREAST trial was a randomized clinical trial conducted between November 2, 2015, and October 31, 2021, performed in 7 hospitals across the Netherlands. Follow-up was 12 months. Referrals could be obtained from general practitioners and all departments from participating or nonparticipating hospitals. The patients with breast cancer who had undergone mastectomy and were seeking breast reconstruction were screened for eligibility (radiotherapy history and physique) by participating plastic surgeons. Patients receiving postmastectomy radiotherapy were excluded. Interventions Breast reconstruction with AFT plus expansion or 2-phased IBR. Randomization was done in a 1:1 ratio. Main Outcomes and Measures The statistical analysis was performed per protocol. The predefined primary outcome was QoL at 12 months after final surgery. This was measured by the BREAST-Q questionnaire, a validated breast reconstruction surgery questionnaire. Questions on the BREAST-Q questionnaire are scored from 0 to 100, with a higher score indicating greater satisfaction or better QoL (depending on the scale). Secondary outcomes were breast volume and the safety and efficacy of the techniques. Results A total of 193 female patients (mean [SD] age, 49.2 [10.6] years) 18 years or older who desired breast reconstruction were included, of whom 91 patients in the AFT group (mean [SD] age, 49.3 [10.3] years) and 80 in the IBR group (mean age, 49.1 [11.0] years) received the allocated intervention. In total, 64 women in the AFT group and 68 women in the IBR group completed follow-up. In the IBR group, 18 patients dropped out mainly due to their aversion to implant use while in the AFT group 6 patients ended their treatment prematurely because of the burden (that is, the treatment being too heavy or tiring). The BREAST-Q scores were higher in the AFT group in all 5 domains and significantly higher in 3: satisfaction with breasts (difference, 9.9; P = .002), physical well-being: chest (difference; 7.6; P = .007), and satisfaction with outcome (difference, 7.6; P = .04). Linear mixed-effects regression analysis showed that QoL change over time was dependent on the treatment group in favor of AFT. The mean (SD) breast volume achieved differed between the groups (AFT: 300.3 [111.4] mL; IBR: 384.1 [86.6] mL). No differences in oncological serious adverse events were found. Conclusions and Relevance This randomized clinical trial found higher QoL and an increase in QoL scores over time in the AFT group compared with the IBR group. No evidence was found that AFT was unsafe. This is encouraging news since it provides a third, less invasive reconstruction option for patients with breast cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02339779.
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Affiliation(s)
- Andrzej A. Piatkowski
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Jamilla L. M. Wederfoort
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Juliette E. Hommes
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Sander S. J. Schop
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Todor K. Krastev
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - René R. W. J. van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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BREAST-Q Patient-reported Outcomes in Different Types of Breast Reconstruction after Fat Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4814. [PMID: 36845864 PMCID: PMC9946430 DOI: 10.1097/gox.0000000000004814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/14/2022] [Indexed: 02/24/2023]
Abstract
Breast reconstruction after mastectomy improves patient quality of life. Independently of the type of reconstruction, ancillary procedures are sometimes necessary to improve results. Fat grafting to the breast is a safe procedure with excellent results. We report patient-reported outcomes using the BREAST-Q questionnaire after autologous fat grafting in different types of reconstructed breasts. Methods We performed a single-center, prospective, comparative study that compared patient-reported outcomes using the BREAST-Q in patients after different types of breast reconstruction (autologous, alloplastic, or after breast conserving) who subsequently had fat grafting. Results In total, 254 patients were eligible for the study, but only 54 (68 breasts) completed all the stages needed for inclusion. Patient demographic and breast characteristics are described. Median age was 52 years. The mean body mass index was 26.1 ± 3.9. The mean postoperative period at the administration of BREAST-Q questionnaires was 17.6 months. The mean preoperative BREAST-Q was 59.92 ± 17.37, and the mean postoperative score was 74.84 ± 12.48 (P < 0.0001). There was no significant difference when divided by the type of reconstruction. Conclusion Fat grafting is an ancillary procedure that improves the outcomes in breast reconstruction independently of the reconstruction type and heightens patient satisfaction, and it should be considered an integral part of any reconstruction algorithm.
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Wei H, Zhang M, Li Q, Shen C, Zhang H, Jin P, Zhang A. Correction of breast asymmetry by autologous fat grafting with the aid of 3D laser-scanning technology. Asian J Surg 2023; 46:458-464. [PMID: 35753912 DOI: 10.1016/j.asjsur.2022.05.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/31/2022] [Accepted: 05/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Currently, the lack of clinically accurate measurement and evaluation methods for breast asymmetry has considerably limited the use of autologous fat grafting in the correction of breast asymmetry. OBJECTIVE This study calculated the volume difference in the bilateral breasts by three-dimensional (3D) laser scanning technology, established a bridge between digitalization and surgery to guide the correction of breast asymmetry by autologous fat grafting, and evaluated the surgical effect. METHODS In the experimental group (3D group), the measurement range was defined by standardized methods, the algorithm to calculate the volume difference in the bilateral breasts was determined by the established software instructions, and the volume of intraoperative autologous fat grafting was guided by personalized data. In the control group, the volume of intraoperative autologous fat grafting was determined based on the surgeon's visual assessment and surgical experience. RESULTS The volume difference in the bilateral breasts was less at 12 months after surgery (P < 0.05), the satisfaction of patients was higher (P < 0.05), and the reoperation rate was lower (P < 0.05). The incidence of postoperative complications was low in both groups (P > 0.05). CONCLUSIONS 3D laser scanning technology can be used as a bridge between digitalization and surgery to significantly improve the surgical effect of autologous fat grafting in the correction of breast asymmetry, with high patient satisfaction and high clinical application value.
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Affiliation(s)
- Hanxiao Wei
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | | | - Qiang Li
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Caiqi Shen
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | | | - Peisheng Jin
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China.
| | - Aijun Zhang
- Xuzhou Medical University Affiliated Hospital, Xuzhou, China.
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Kuruvilla AS, Yan Y, Rathi S, Wang F, Weichman KE, Ricci JA. Oncologic Safety in Autologous Fat Grafting After Breast Conservation Therapy: A Systematic Review and Meta-analysis of the Literature. Ann Plast Surg 2023; 90:106-110. [PMID: 36534109 DOI: 10.1097/sap.0000000000003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Autologous fat grafting (AFG) is often used to reconstruct defects after breast conservation therapy (BCT). However, concerns exist about the possibility of AFG-related recurrence or metastasis. This study aims to evaluate the literature to evaluate oncologic outcomes in patients undergoing AFG at the time of BCT. METHODS A systematic review of articles related to AFG based reconstruction at the time of BCT from 1970 to 2021 was performed via PubMed. Patients were grouped based on the presence or lack of AFG usage at the time of BCT, and oncologic outcomes and complications were compared. RESULTS Of the 146 articles identified, 15 were included. Nine hundred patients underwent BCT alone and 1063 patients underwent BCT with AFG patients. Similar average follow-up time was observed between the groups, 58.7 months (BCT only) and 55.2 months (BCT with AFG). On pooled analysis, no difference was identified in local recurrence 4.8% (43 patients) of the BCT group and 3% (32 patients) in the AFG group (P = 0.8), metastasis 4.8% (43 patients) of the BCT group and 6.9% (73 patients) in the AFG group (P = 0.3), or fat necrosis (P = 0.44). Meta-analysis additionally did not identify any statistically significant odds ratios between the BCT only group and BCT with AFG group when evaluated for total recurrence, local recurrence, metastasis or fat necrosis. CONCLUSIONS The results show no significant difference in cancer recurrence or metastasis in the BCT only group versus BCT and AFG, showing that fat grafting has safe outcomes.
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Affiliation(s)
- Annet S Kuruvilla
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Yufan Yan
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
| | - Sourish Rathi
- New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, NY
| | - Fei Wang
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
| | - Katie E Weichman
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
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Simultaneous Contralateral Autologous Breast Augmentation during Unilateral Breast Reconstruction Utilizing Deep Inferior Epigastric Flaps. Plast Reconstr Surg Glob Open 2022; 10:e4498. [PMID: 36119381 PMCID: PMC9473798 DOI: 10.1097/gox.0000000000004498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
It is predicted that 281,550 new cases of invasive breast cancer and 49,290 new cases of ductal carcinoma in situ will be diagnosed this year. In this study, we will detail our experience with simultaneous contralateral autologous breast augmentation during unilateral breast reconstruction utilizing bilateral deep inferior epigastric perforator (DIEP) flaps. Methods A retrospective analysis of patients who underwent simultaneous contralateral autologous breast augmentation during unilateral breast reconstruction utilizing bilateral DIEP flaps by the senior surgeons at Beaumont Health Systems, Royal Oak, was conducted. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively analyzed. Results Seven patients who met the inclusion criteria were identified. One patient underwent immediate reconstruction with DIEP flaps, one patient had a history of lumpectomy and underwent delayed partial breast reconstruction, three patients had delayed unilateral DIEP breast reconstruction with contralateral breast augmentation, and two patients had previous augmentations that were revised. All patients examined in this review tolerated the procedures well and had clinically viable flaps along with superior aesthetic outcomes. Conclusions This technique can be applied to various clinical conditions, including immediate breast reconstruction, delayed breast reconstruction, and salvage for failed implant-based reconstruction, leading to optimal patient outcomes and satisfaction. Unilateral breast reconstruction with simultaneous contralateral autologous breast augmentation utilizing bilateral DIEP flaps is a surgical technique that more plastic surgeons should utilize.
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The Importance of Protecting the Structure and Viability of Adipose Tissue for Fat Grafting. Plast Reconstr Surg 2022; 149:1357-1368. [PMID: 35404340 DOI: 10.1097/prs.0000000000009139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Fat grafting is widely used for soft-tissue augmentation; however, the related clinical outcome remains variable and technique-dependent. The mechanisms underlying fat graft survival are not fully understood, particularly regarding the contributions of different cell types, such as functional adipocytes. This study evaluated the importance of adipose tissue structure and viability in fat grafting and, to some extent, revealed the effect of adipocytes in fat grafting. METHODS Human lipoaspirate was harvested using suction-assisted liposuction and processed using three separate methods: cotton-pad filtration, soft centrifugation (400 g for 1 minute), and Coleman centrifugation (1200 g for 3 minutes). Then all samples were subjected to second cotton-pad concentration. Adipose tissue structure and viability, the numbers of adipose-derived stem cells, and their proliferation and multilineage differentiation abilities were compared in vitro. The volume retention rate and fat graft quality were evaluated in vivo. RESULTS Cell structure destruction and viability decline were more evident in the Coleman centrifugation group compared to the cotton-pad filtration group and the soft centrifugation group. However, no intergroup differences were observed in the numbers, proliferation, or multilineage differentiation abilities of adipose-derived stem cells. After transplantation, the volume retention rates were similar in the three groups. However, greater structural and functional damage was associated with poorer graft quality, including decreased levels of graft viability, vessel density, and vascular endothelial growth factor secretion and increased levels of vacuoles, necrotic areas, fibrosis, and inflammation. CONCLUSIONS Protecting adipose tissue structure and viability is crucial for improving fat grafting outcomes. CLINICAL RELEVANCE STATEMENT The protection of the structure and viability of adipose tissue should be ensured throughout the whole process of fat grafting to reduce complications and improve graft quality.
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Winkler NS, Tran A, Kwok AC, Freer PE, Fajardo LL. Autologous Fat Grafting to the Breast: An Educational Review. JOURNAL OF BREAST IMAGING 2022; 4:209-221. [PMID: 38422423 DOI: 10.1093/jbi/wbab055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Indexed: 03/02/2024]
Abstract
Autologous fat grafting (AFG) is a technique that is increasingly utilized in breast cosmetic and reconstructive surgery. In this procedure, fat is aspirated by liposuction from one area of the body and injected into the breast. The procedure and process of AFG has evolved over the last few decades, leading to more widespread use, though there is no standard method. Autologous fat grafting is generally considered a safe procedure but may result in higher utilization of diagnostic imaging due to development of palpable lumps related to fat necrosis. Imaging findings depend on surgical technique but typically include bilateral, symmetric, retromammary oil cysts and scattered dystrophic and/or coarse calcifications when AFG is used for primary breast augmentation. More focal findings occur when AFG is used to improve specific areas of cosmetic deformity, scarring, or pain following breast cancer surgery. As with any cause of fat necrosis, imaging features tend to appear more benign over time, with development of rim calcifications associated with oil cysts and a shift in echogenicity of oil cyst contents on ultrasound towards anechoic in some cases. This article reviews the AFG procedure, uses, complications, and imaging findings.
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Affiliation(s)
- Nicole S Winkler
- University of Utah and Huntsman Cancer Institute, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Alexander Tran
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alvin C Kwok
- University of Utah and Huntsman Cancer Institute, Department of Plastic Surgery, Salt Lake City, UT, USA
| | - Phoebe E Freer
- University of Utah and Huntsman Cancer Institute, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Laurie L Fajardo
- University of Utah and Huntsman Cancer Institute, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
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12
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Bi X, Li Y, Dong Z, Zhao J, Wu W, Zou J, Guo L, Lu F, Gao J. Recent Developments in Extracellular Matrix Remodeling for Fat Grafting. Front Cell Dev Biol 2021; 9:767362. [PMID: 34977018 PMCID: PMC8716396 DOI: 10.3389/fcell.2021.767362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Remodeling of the extracellular matrix (ECM), which provides structural and biochemical support for surrounding cells, is vital for adipose tissue regeneration after autologous fat grafting. Rapid and high-quality ECM remodeling can improve the retention rate after fat grafting by promoting neovascularization, regulating stem cells differentiation, and suppressing chronic inflammation. The degradation and deposition of ECM are regulated by various factors, including hypoxia, blood supply, inflammation, and stem cells. By contrast, ECM remodeling alters these regulatory factors, resulting in a dynamic relationship between them. Although researchers have attempted to identify the cellular sources of factors associated with tissue regeneration and regulation of the microenvironment, the factors and mechanisms that affect adipose tissue ECM remodeling remain incompletely understood. This review describes the process of adipose ECM remodeling after grafting and summarizes the factors that affect ECM reconstruction. Also, this review provides an overview of the clinical methods to avoid poor ECM remodeling. These findings may provide new ideas for improving the retention of adipose tissue after fat transplantation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jianhua Gao
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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13
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Laustsen-Kiel CM, Lauritzen E, Langhans L, Engberg Damsgaard T. Study protocol for a 10-year prospective observational study, examining lymphoedema and patient-reported outcome after breast reconstruction. BMJ Open 2021; 11:e052676. [PMID: 34873005 PMCID: PMC8650483 DOI: 10.1136/bmjopen-2021-052676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Over the last decades, treatment of breast cancer has become increasingly more effective. Consequently, an increasing number of women are living with late effects of breast cancer treatment, including disfiguring scars, deformity or asymmetry of the breast, secondary lymphoedema and other physical and psychosocial late effects. Data from this study will provide knowledge on how to guide breast reconstruction in the future towards outcomes with fewer complications, higher long-term quality of life (QoL) and satisfaction with the aesthetic outcome. The development of secondary lymphoedema, for which the effect of breast reconstruction has yet to be established, will be thoroughly examined. METHODS AND ANALYSIS Women receiving breast reconstruction (autologous and implant based) at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, will be invited to participate. The patients will be followed for 10 years postoperatively. Demographic, health-related, oncological characteristics and treatment data will be registered. Validated assessment tools, such as the BREAST-Q and Beck Depression Inventory, will be used to measure an extensive range of clinical outcomes, including QoL, life and aesthetic satisfaction and depression. Arm range of motion will be measured with a goniometer and lymphoedema by bioimpedance spectroscopy, compared with circular arm measurements. ETHICS AND DISSEMINATION This study will be conducted according to the 5th version of the Helsinki Declaration. The regional ethical committee for Capital Region Denmark did not find the study notifiable, according to the law of the committee § 1, part 4. All data will be anonymised before its publication. This study will be conducted according to the Danish data protection regulation and is catalogued and approved by the Capital Region Head of Knowledge Centre. According to the Danish health law § 46, part 2, this study does not need the Danish Patient Safety Authority's approval. The findings of this study will be submitted to international peer-reviewed journals.
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Affiliation(s)
| | - Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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14
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Moak TN, Ebersole TG, Tandon D, Tenenbaum M. Assessing Clinical Outcomes in Autologous Fat Grafting: A Current Literature Review. Aesthet Surg J 2021; 41:S50-S60. [PMID: 34002770 DOI: 10.1093/asj/sjab148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Autologous fat grafting, first described in the 1890s, has since undergone many modifications to optimize safety and efficacy. These changes have resulted in the technique that we now consider standard of care, one that is applied to reconstruction and cosmetic enhancement of the breast and the face both independently and in conjunction with surgical treatment. There is a growing body of evidence that this application has positive outcomes for patient satisfaction, surgeon satisfaction, and overall aesthetic appearance. This article summarizes the body of literature regarding these outcomes, reviews complications of fat grafting in the face and breast, and discusses controversies including radiologic imaging changes and longevity of grafting. Level of Evidence: 4.
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Affiliation(s)
- Teri N Moak
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Barnes Jewish Hospital, Washington University, St. Louis, MO, USA
| | - Trina G Ebersole
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Barnes Jewish Hospital, Washington University, St. Louis, MO, USA
| | - Damini Tandon
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Barnes Jewish Hospital, Washington University, St. Louis, MO, USA
| | - Marissa Tenenbaum
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Barnes Jewish Hospital, Washington University, St. Louis, MO, USA
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15
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Safety and Effectiveness of Autologous Fat Grafting after Breast Radiotherapy: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2021; 147:1-10. [PMID: 33370043 DOI: 10.1097/prs.0000000000007416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and effectiveness of autologous fat grafting after radiotherapy. METHODS All studies published before December of 2019 were collected by searching on PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, and Wanfang Data. After independently screening the studies and extracting the data, Stata was applied to perform meta-analysis. RESULTS Seventeen qualified articles were eventually included, involving a total of 1658 patients, of which 1555 underwent autologous fat grafting. Overall, empirically from the data, the use of autologous fat grafting after radiotherapy does not increase the incidence of complications or the risk of tumor recurrence. Through statistical analysis, the authors found that 152 patients suffered complications after undergoing autologous fat grafting [152 of 1555 (9.8 percent)]; 72 patients suffered complications after undergoing postradiotherapy autologous fat grafting [72 of 1040 (6.9 percent)], including seven cases of tumor recurrence [seven of 1040 (0.7 percent)]; and 80 patients suffered complications after undergoing autologous fat grafting without radiotherapy [80 of 515 (15.5 percent)], including seven cases of tumor recurrence [seven of 515 (1.4 percent)]. The authors also found that 970 of 1040 patients (93.3 percent) were satisfied with the results of postradiotherapy autologous fat grafting for breast reconstruction. CONCLUSIONS This study has provided an evidence-based conclusion supporting the use of autologous fat grafting for breast reconstruction after radiotherapy. Autologous fat grafting can effectively correct breast deformity and contracture caused by breast-conserving therapy and radiotherapy and increase patient satisfaction without increasing the rate of tumor recurrence.
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Zhang SL, Song J, Wang YR, Guo YJ, Zhao JZ, Sun L, Huang LT, Ma JT, Han CB. Short-term outcomes and safety of radiotherapy for immediate breast reconstruction with autologous flap transfer following breast-conserving surgery. BMC Cancer 2021; 21:214. [PMID: 33653297 PMCID: PMC7923603 DOI: 10.1186/s12885-021-07915-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer. METHOD A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. RESULTS In total, 84 breast cancer patients were enrolled, with 32 patients in the RT group and 52 in the non-RT group. At a median follow-up time of 33.3 months, no significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P = 1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P < 0.001). No significant difference in the reduction of flap size was observed at any timepoint between the two groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P > 0.05). Additionally, no grade 3 or greater RT-associated adverse events occurred during or after RT. CONCLUSION RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.
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Affiliation(s)
- Shu-Ling Zhang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jun Song
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yan-Ru Wang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yi-Jia Guo
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jian-Zhu Zhao
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Li Sun
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Le-Tian Huang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jie-Tao Ma
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Cheng-Bo Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Kaidar-Person O, Hermann N, Poortmans P, Offersen BV, Boersma LJ, de Ruysscher D, Tramm T, Kühn T, Engberg Damsgaard T, Gentilini O, Maarse W, Sklair-Levi M, Mátrai Z. A multidisciplinary approach for autologous breast reconstruction: A narrative (re)view for better management. Radiother Oncol 2021; 157:263-271. [PMID: 33582192 DOI: 10.1016/j.radonc.2021.01.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/16/2023]
Abstract
Breast reconstruction and oncoplastic surgery have become an important part of breast cancer care. The use of autologous breast reconstruction (ABR) has evolved significantly with advances in microsurgery, aiming to reduce donor site complications and improve cosmesis. For years, immediate-ABR was considered a contraindication if postmastectomy irradiation (PMRT) was planned. As a result of de-escalation of axillary surgery the indication of PMRT are increasing along-side with observations that PMRT in the setting of ABR is not contraindicated. Surgical techniques may result in different amount and areas of breast residual glandular tissue and patient selection is important to reduce potential residual disease. Meticulus radiation planning is important to potentially reduce complications without compromising oncologic outcomes. Surgical techniques change constantly in aim to improve aesthetic results but should most importantly maintain priority to the oncological indications. By multidisciplinary team work with a comprehensive understanding of each discipline, we can preserve the accomplishments of breast surgery in the setting of PMRT, without compromising disease control.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, at Sheba Medical Center, Ramat Gan, Israel; GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, The Netherlands; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Naama Hermann
- Sackler School of Medicine, Tel-Aviv University, Israel; General Surgery B and The Meirav Breast Center, Sheba Medical Center
| | - Philip Poortmans
- Iridium Kankernetwerk, 2610 Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, 2610 Wilrijk-Antwerp, Belgium
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Denmark
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Esslingen, Germany
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital and University of Copenhagen, Denmark
| | - Oreste Gentilini
- Breast Surgery Unit, San Raffaele University and Research Hospital, Milano, Italy
| | - Wies Maarse
- Departmentof Plastic and Reconstructive Surgery, University Medical Centre Utrecht, the Netherlands
| | - Miri Sklair-Levi
- Sackler School of Medicine, Tel-Aviv University, Israel; Radiology Department, Mercaz Mierav Breast Clinic, Sheba Tel Hashomer, Ramat Gan, Israel
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary, Budapest, Hungary
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Fang J, Chen F, Liu D, Gu F, Wang Y. Adipose tissue-derived stem cells in breast reconstruction: a brief review on biology and translation. Stem Cell Res Ther 2021; 12:8. [PMID: 33407902 PMCID: PMC7789635 DOI: 10.1186/s13287-020-01955-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023] Open
Abstract
Recent developments in adipose-derived stromal/stem cell (ADSC) biology provide new hopes for tissue engineering and regeneration medicine. Due to their pluripotent activity, paracrine activity, and immunomodulatory function, ADSCs have been widely administrated and exhibited significant therapeutic effects in the treatment for autoimmune disorders, neurodegenerative diseases, and ischemic conditions both in animals and human clinical trials. Cell-assisted lipotransfer (CAL) based on ADSCs has emerged as a promising cell therapy technology and significantly improved the fat graft retention. Initially applied for cosmetic breast and facial enhancement, CAL has found a potential use for breast reconstruction in breast cancer patients. However, more challenges emerge related to CAL including lack of a standardized surgical procedure, the controversy in the effectiveness of CAL, and the potential oncogenic risk of ADSCs in cancer patients. In this review, we summarized the latest research and intended to give an outline involving the biological characteristics of ADSCs as well as the preclinical and clinical application of ADSCs.
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Affiliation(s)
- Jun Fang
- Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.,Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China.,Radiotherapy, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Feng Chen
- Department of Breast Tumor Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Dong Liu
- Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.,Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China.,Radiotherapy, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Feiying Gu
- Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.,Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China.,Radiotherapy, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yuezhen Wang
- Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China. .,Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China. .,Radiotherapy, Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.
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19
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Zhang X, Cai L, Yin B, Han X, Li F. Total breast reconstruction using large-volume condensed and viable fat grafting after mastectomy. J Plast Reconstr Aesthet Surg 2020; 74:966-973. [PMID: 33341385 DOI: 10.1016/j.bjps.2020.10.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/29/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023]
Abstract
Autologous fat grafting (AFG) has become a third alternative for breast reconstruction after mastectomy. However, total breast reconstruction using AFG remains a great challenge. We performed breast reconstruction using large-volume condensed and viable fat grafting in 30 postmastectomy patients (irradiated, n = 9; nonirradiated, n = 21). The grafts were purified and condensed by the washing and cotton gauze rolling technique. The surgical maneuver is designed to preserve the grafts viability. Three-dimensional expansion was applied where strong adhesions were present. Seven patients wore the Brava device for the expansion of the recipient site. The mean (SD) volume of fat grafted in each procedure was 230.5 (57.8) mL. The average number of sessions was 3.3 (0.7). The irradiated patients required more sessions than the nonirradiated patients (p=.017). The mean follow-up period was 12.8 (4.3) months. One patient (3%) developed postoperative cellulitis. Cysts and palpable nodules occurred in eight patients (27%) and one patient (3%), respectively. Severe dermatitis and skin pigmentation change occurred in one patient wearing the Brava device. The esthetic scores significantly improved after the treatments (p<.001). Approximately 90% of the patients were satisfied. No local recurrence or remote metastasis was documented during the follow-up period. Our study showed the success of total breast reconstruction using AFG. As a third alternative for breast reconstruction, total breast reconstruction using large volume condensed and viable fat grafting is an effective and safe approach for postmastectomy patients.
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Affiliation(s)
- Xinyu Zhang
- Department of Body Contouring and Liposuction Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 6 Xiaozhuang Road, Chaoyang District, Beijing, 100026, China
| | - Lei Cai
- Department of Body Contouring and Liposuction Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 6 Xiaozhuang Road, Chaoyang District, Beijing, 100026, China
| | - Bo Yin
- Department of Body Contouring and Liposuction Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 6 Xiaozhuang Road, Chaoyang District, Beijing, 100026, China
| | - Xuefeng Han
- Department of Body Contouring and Liposuction Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 6 Xiaozhuang Road, Chaoyang District, Beijing, 100026, China.
| | - Facheng Li
- Department of Body Contouring and Liposuction Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 6 Xiaozhuang Road, Chaoyang District, Beijing, 100026, China.
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20
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Hanson SE, Kapur SK, Garvey PB, Hernandez M, Clemens MW, Hwang RF, Dryden MJ, Butler CE. Oncologic Safety and Surveillance of Autologous Fat Grafting following Breast Conservation Therapy. Plast Reconstr Surg 2020; 146:215-225. [PMID: 32740564 DOI: 10.1097/prs.0000000000006974] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Autologous fat grafting is a useful adjunct following breast reconstruction. The impact of autologous fat grafting on oncologic safety and surveillance remains questionable, particularly following breast conservation therapy. METHODS The authors performed a retrospective review of patients who underwent delayed fat grafting following breast conservation therapy between 2006 and 2016. A control group of conservatively managed patients without grafting was matched for cancer stage, age, body mass index, and follow-up. Outcomes included locoregional recurrence and oncologic surveillance. RESULTS Seventy-two patients were identified per cohort. There were no differences in median age (50 years versus 51 years; p = 0.87), body mass index (28.2 kg/m versus 27.2 kg/m; p = 0.38), or length of follow-up (61.9 months versus 66.8 months; p = 0.144) between controls and grafted patients, respectively. Overall, four patients in each cohort experienced recurrence (5.6 percent; p = 1.00) with similar cumulative incidence estimates observed (log-rank test, p = 0.534). There were no significant differences in palpable mass (9.7 percent versus 19.4 percent; p = 0.1), fat necrosis (34.7 percent versus 33.3 percent; p = 0.86), calcifications (37.5 percent versus 34.7 percent; p = 0.73), or indication for breast biopsy (15.3 percent versus 22.2 percent; p = 0.23) between breast conservation and breast conservation therapy plus autologous fat grafting cohorts, respectively. CONCLUSIONS Overall, the authors found no difference in recurrence rates after breast conservation with or without delayed fat grafting. Furthermore, there were no differences in the rates of fat necrosis, palpable mass, and abnormal radiographic findings. This study represents the longest follow-up to date in in a large matched study of autologous fat grafting with breast conservation therapy demonstrating oncologic safety and no interference with follow-up surveillance. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Summer E Hanson
- From the Departments of Plastic Surgery, Biostatistics, Breast Surgical Oncology, and Diagnostic Radiology, Breast Imaging Section, University of Texas M. D. Anderson Cancer Center
| | - Sahil K Kapur
- From the Departments of Plastic Surgery, Biostatistics, Breast Surgical Oncology, and Diagnostic Radiology, Breast Imaging Section, University of Texas M. D. Anderson Cancer Center
| | - Patrick B Garvey
- From the Departments of Plastic Surgery, Biostatistics, Breast Surgical Oncology, and Diagnostic Radiology, Breast Imaging Section, University of Texas M. D. Anderson Cancer Center
| | - Mike Hernandez
- From the Departments of Plastic Surgery, Biostatistics, Breast Surgical Oncology, and Diagnostic Radiology, Breast Imaging Section, University of Texas M. D. Anderson Cancer Center
| | - Mark W Clemens
- From the Departments of Plastic Surgery, Biostatistics, Breast Surgical Oncology, and Diagnostic Radiology, Breast Imaging Section, University of Texas M. D. Anderson Cancer Center
| | - Rosa F Hwang
- From the Departments of Plastic Surgery, Biostatistics, Breast Surgical Oncology, and Diagnostic Radiology, Breast Imaging Section, University of Texas M. D. Anderson Cancer Center
| | - Mark J Dryden
- From the Departments of Plastic Surgery, Biostatistics, Breast Surgical Oncology, and Diagnostic Radiology, Breast Imaging Section, University of Texas M. D. Anderson Cancer Center
| | - Charles E Butler
- From the Departments of Plastic Surgery, Biostatistics, Breast Surgical Oncology, and Diagnostic Radiology, Breast Imaging Section, University of Texas M. D. Anderson Cancer Center
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21
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22
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Turner A, Abu-Ghname A, Davis MJ, Winocour SJ, Hanson SE, Chu CK. Fat Grafting in Breast Reconstruction. Semin Plast Surg 2020; 34:17-23. [PMID: 32071575 DOI: 10.1055/s-0039-1700959] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The past two decades have witnessed a growing application of autologous fat grafting in the setting of breast reconstruction after surgical treatment of breast cancer. While traditionally used to correct contour deformities during secondary revisions, fat grafting has since evolved to achieve desired breast shape and size both as a complementary adjunct to established reconstructive techniques as well as a standalone technique for whole breast reconstruction. In this article, we will review fat grafting as an adjunct to autologous and implant-breast based reconstruction, an option for primary breast reconstruction, and a treatment of postmastectomy pain.
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Affiliation(s)
- Acara Turner
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sebastian J Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Summer E Hanson
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carrie K Chu
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
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23
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Wu J, Yan C, Wang L, Yang Y, Ling R, Li N. Oncoplastic technique using a lateral mammary adipofascial flap for the breast-conserving reconstruction. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:794. [PMID: 32042810 DOI: 10.21037/atm.2019.12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Achieving satisfactory cosmetic results after breast-conserving surgery (BCS) can be difficult for breast cancer patients with large tumors. To avoid breast asymmetries and deformation, we present a case of breast reconstruction after BCS with a lateral mammary adipofascial flap, which was dissociated along the sentinel lymph node biopsy incision. During the procedure, the pedicled flap was transferred into the residual tumor cavity through a tunnel between them and then matched the residual cavity. The sufficient blood supply of the transferred flap was observed in ultrasound at follow-up. The operative is straightforward to perform and less invasive. No operative complications were observed. The cosmetic results were found to be good with a natural shape, volume, and symmetry, and with which the patient has reported high satisfaction. This procedure offers a new possibility in breast reconstruction and is worth considering as a new option for immediate repair after BCS.
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Affiliation(s)
- Jiang Wu
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Changjiao Yan
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Lei Wang
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Yuqing Yang
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Rui Ling
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Nanlin Li
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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The use of autologous fat grafts in breast surgery: A literature review. Arch Plast Surg 2019; 46:498-510. [PMID: 31775202 PMCID: PMC6882697 DOI: 10.5999/aps.2019.00416] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022] Open
Abstract
Autologous fat injection was first described roughly a century ago and has been used in surgery ever since. In addition to its use in many surgical fields, it is also frequently used for both aesthetic and reconstructive purposes in breast surgery. Since the application of fat grafting in breast surgery has steadily increased, studies investigating its reliability have simultaneously become increasingly common. Previous studies have reported that the use of fat grafting in breast surgery is reliable, but some pending questions remain about its routine use. In order to use fat grafts successfully in breast surgery, it is necessary to be familiar with the structure and content of adipose tissue, the efficacy of adipose stem cell-enriched fat grafts, the oncological safety of fat grafts, and the problems that may occur in the radiological follow-up of patients who undergo fat grafting procedures. In this literature review, we aim to discuss the use of fat grafts in breast surgery by investigating these common problems.
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Kümmel A, Kümmel S, Blohmer JU, Faridi A, Nitz U, Loibl S, von Fritschen U, Rezek D, Hagemann F, Holtschmidt J, Botzenhardt S, Reinisch M. Autologous Lipotransfer - Daily Therapeutic Practice in Breast Cancer: An Intergroup Analysis Encompassing NOGGO, WSG, GBG, AWO Gyn and DGPRÄC. Breast Care (Basel) 2019; 14:165-169. [PMID: 31316315 DOI: 10.1159/000490040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Autologous fat transfer in breast reconstruction has become increasingly important in breast reconstructive surgery. Although the indication to obtain fat, the various operative procedures, and the risks for the patient have been addressed in a large number of studies, detailed information on the everyday use of autologous lipotransfer in breast units in Germany is still lacking. Methods The objective of the study was to obtain primary data on the use of autologous lipotransfer to treat breast cancer patients in Germany and to determine measures for quality assurance in the daily practice. An online questionnaire concerning breast cancer and lipofilling was sent to specialists in gynecology and plastic surgery. Results Two-thirds of the specialists who responded to the questionnaire use autologous lipotransfer for breast reconstruction and did not report an increase of local recurrence following lipotransfer. There were only small differences between gynecologists and plastic surgeons regarding the procedure and indication for lipotransfer. The method is highly accepted by patients and physicians, and both gynecologists and plastic surgeons rated the improvement achieved through lipofilling as 'high'. Conclusions The lack of randomized controlled data, especially in high-risk patients, demonstrates the necessity for a registry study on this topic. Our survey describes, in detail, the indications for lipofilling as well as its appropriate application in breast cancer patients in Germany and may thereby reduce the present therapeutic uncertainties.
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Affiliation(s)
- Aylin Kümmel
- Breast Unit, Kliniken Essen Mitte, Essen, Germany
| | | | - Jens-Uwe Blohmer
- Department of Obstetrics and Gynecology, Breast Unit, Berlin, Germany
| | - Andree Faridi
- Brustzentrum Universitätsklinik Bonn, Universitätskliniken Bonn, Bonn, Germany
| | - Ulrike Nitz
- Brustzentrum Niederrhein, Evangelisches Bethesda-Krankenhaus, Mönchengladbach, Germany
| | - Sibylle Loibl
- German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - Uwe von Fritschen
- Plastische und Ästhetische Chirurgie, HELIOS Klinikum Emil von Behring, Berlin, Germany
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