Camile Cesa Stumpf1, Ângela Erguy Zucatto2, José Antônio Crespo Cavalheiro2, Marcia Portela de Melo2, Rodrigo Cericato2, Andréa Pires Souto Damin3,4,2, Jorge Villanova Biazús3,4,2. 1. Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro 2350/600C, Porto Alegre, RS, 90035-903, Brazil. dra.camilestumpf@gmail.com. 2. Mastology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil. 3. Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro 2350/600C, Porto Alegre, RS, 90035-903, Brazil. 4. Department of Gynecology and Obstetrics, Medical School, UFRGS, Porto Alegre, RS, Brazil.
Abstract
IMPORTANCE: Autologous fat grafting (AFG), or lipofilling, has been used for immediate reconstruction at the time of breast-conserving surgery in order to achieve a satisfactory cosmetic outcome in patients with breast cancer and an unfavorable tumor-to-breast volume ratio or unfavorable tumor location. However, the oncologic safety of this technique is still unclear. OBJECTIVE: To determine whether AFG performed simultaneously with breast-conserving surgery is associated with differences in local relapse rates and disease-free survival. DESIGN: Matched retrospective cohort study. SETTING: Tertiary referral center. PARTICIPANTS: Patients undergoing breast-conserving surgery with or without AFG between 2004 and 2016 were retrospectively enrolled and matched for age, staging, grade, tumor histology, and tumor immunohistochemical profile. MAIN OUTCOME(S) AND MEASURE(S): The cumulative incidence of locoregional recurrence (LRR) and disease-free survival were the primary end points, while distant recurrence and overall survival were the secondary end points. RESULTS: A total of 320 patients were followed. Cases were matched with controls at a 1:4 ratio. There was no difference in LRR or distant recurrence of breast cancer between the two groups. The annual LRR rate was 0.86% in patients who received immediate AFG vs. 0.7% in patients undergoing breast-conserving surgery alone (p ≥ 0.05). Number of lymph nodes was the sole independent risk factor for local recurrence (p = 0.045). No significant differences in disease-free survival rates were found between the groups. CONCLUSIONS AND RELEVANCE: At a mean follow-up of 5 years, no significant differences in locoregional recurrence rates were found between patients who received immediate AFG and those who underwent breast-conserving surgery alone. These findings corroborate previous research demonstrating the oncological safety of immediate AFG reconstruction, further suggesting that this technique as a safe, effective way to achieve optimal cosmetic outcomes in primary breast cancer surgery without jeopardizing oncologic outcomes.
IMPORTANCE: Autologous fat grafting (AFG), or lipofilling, has been used for immediate reconstruction at the time of breast-conserving surgery in order to achieve a satisfactory cosmetic outcome in patients with breast cancer and an unfavorable tumor-to-breast volume ratio or unfavorable tumor location. However, the oncologic safety of this technique is still unclear. OBJECTIVE: To determine whether AFG performed simultaneously with breast-conserving surgery is associated with differences in local relapse rates and disease-free survival. DESIGN: Matched retrospective cohort study. SETTING: Tertiary referral center. PARTICIPANTS: Patients undergoing breast-conserving surgery with or without AFG between 2004 and 2016 were retrospectively enrolled and matched for age, staging, grade, tumor histology, and tumor immunohistochemical profile. MAIN OUTCOME(S) AND MEASURE(S): The cumulative incidence of locoregional recurrence (LRR) and disease-free survival were the primary end points, while distant recurrence and overall survival were the secondary end points. RESULTS: A total of 320 patients were followed. Cases were matched with controls at a 1:4 ratio. There was no difference in LRR or distant recurrence of breast cancer between the two groups. The annual LRR rate was 0.86% in patients who received immediate AFG vs. 0.7% in patients undergoing breast-conserving surgery alone (p ≥ 0.05). Number of lymph nodes was the sole independent risk factor for local recurrence (p = 0.045). No significant differences in disease-free survival rates were found between the groups. CONCLUSIONS AND RELEVANCE: At a mean follow-up of 5 years, no significant differences in locoregional recurrence rates were found between patients who received immediate AFG and those who underwent breast-conserving surgery alone. These findings corroborate previous research demonstrating the oncological safety of immediate AFG reconstruction, further suggesting that this technique as a safe, effective way to achieve optimal cosmetic outcomes in primary breast cancer surgery without jeopardizing oncologic outcomes.
Entities:
Keywords:
Autologous fat grafting; Breast cancer; Breast conservative surgery; Immediate breast reconstruction; Recurrence
Authors: Courtney K Brock; Katherine L Hebert; Maria Artiles; Maryl K Wright; Thomas Cheng; Gabrielle O Windsor; Khoa Nguyen; Madlin S Alzoubi; Bridgette M Collins-Burow; Elizabeth C Martin; Frank H Lau; Bruce A Bunnell; Matthew E Burow Journal: Front Physiol Date: 2021-11-29 Impact factor: 4.566