Oncological Recurrence after Autologous Fat Grafting in Breast Reconstruction; Critical appraisal of the current literature on basic science and clinical studies

Abstract

Background The use of Autologous Fat Grafting (AFG) in surgical procedures of the female breast has gained enormous international interest over the last decade with indications ranging from aesthetic augmentation to the treatment of postmastectomy-pain-syndromes and breast-reconstructions. One of the most important unanswered questions remains that of oncological-safety, with an almost equal sum of clinical- and basic-science-studies suggesting oncological-safety and an increased risk of oncological recurrence respectively. In this paper the authors aim to provide a comprehensive overview of the overwhelming data currently available on the subject of oncological-safety after AFG for (breast) reconstructive purposes. Method An extensive literature search was performed using the following databases; PubMed, Embase.com, Wiley/Cochrane Library and Web of Science. Original studies reporting on AFG for (breast) reconstructive purposes were included and a tabulated overview of data regarding oncological-safety from either a clinical- or basic-science point-of-view are provided. Results Thirty-five and twenty-one basic-science- and clinical-studies reported on oncological safety respectively. Thirty-one basicscience-studies described the carcinogenic effects of AFG with most reporting the effects of adipocyte-derived-stemcells in stimulating growth, migration, neo-vascularisation, self-renewal or metastatic-capabilities of different breast-cancer-cell-lines through various pathways. A meta-analysis of clinical-studies on oncological-safety after cancer treatment and breast reconstruction with AFG in a total of 2953 patients reported a locoregional-recurrence-rate of 2.5% and a distant-recurrencerate of 2.0% with no difference between mastectomy and breastconserving-therapy patients (p=0.69). However, a significant higher number of locoregional recurrences compared to a control group were found in two sub-cohorts of intra-epithelial neoplasms. Conclusion It is clear that more scientific data from both basic science studies using clinical breast cancer samples with representable ASC concentrations as well as clinicalstudies, preferably RCT’s, with a clear distinction between breast cancer types and the recurrence risk after breast-conserving therapy are needed in order to make clear assumptions about oncological safety of AFG.