Marco Klinger1, Agnese Losurdo2, Andrea V E Lisa1, Emanuela Morenghi3, Valeriano Vinci1, Fabio Corsi4,5, Sara Albasini5, Maria Cristina Leonardi6, Barbara A Jereczek-Fossa6,7, Paolo Veronesi7,8, Mario Rietjens9, Luca Fabiocchi10, Sonia Santicchia11, Francesco Klinger12, Andrea Loreti13, Lucio Fortunato14, Maria A Bocchiotti15, Fulvio A Nicolò15, Paolo Stringhini16, Pier Camillo Parodi17, Emanuele Rampino17, Valentina Guarneri18,19, Giulia Pagura20, Erica Dalla Venezia21, Graziano Meneghini22, Tanja Kraljic22, Paolo Persichetti23, Mauro Barone23, Nicola Vaia24, Irene Zerini25, Luca Grimaldi25, Michele Riccio26, Angelica Aquinati27, Franco Bassetto28, Vincenzo Vindigni28, Luigi Ciuffreda29, Corrado Tinterri30, Armando Santoro31,32. 1. Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, University of Milan, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy. 2. UO of Medical Oncology, Department of Oncology and Hematology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy. agnese.losurdo@humanitas.it. 3. Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy. 4. Department of Biomedical and Clinical Sciences, "Luigi Sacco", Università di Milano, Milan, Italy. 5. Department of Surgery, Breast Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy. 6. Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy. 7. Department of Oncology and Hematology, University of Milan, Milan, Italy. 8. Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy. 9. Division of Plastic and Reconstructive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy. 10. Plastic Surgery Unit, Breast Unit, Rimini Santarcangelo Hospital, Rimini, Italy. 11. Department of Breast Diagnosis, Breast Unit, Rimini Santarcangelo Hospital, Rimini, Italy. 12. University of Milan, Reconstructive and Aesthetic Plastic Surgery School - MultiMedica Holding S.p.A.- Plastic Surgery Unit - Sesto San Giovanni, Milan, Italy. 13. Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy. 14. Breast Surgery Unit, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy. 15. Department of Plastic and Reconstructive Surgery, Università Città della Salute e della Scienza, Torino, Italy. 16. Reconstructive Surgery, Fondazione Poliambulanza Brescia, Brescia, Italy. 17. Department of Medical, Experimental and Clinical Sciences - Plastic and Aesthetic Surgery, University of Udine, Udine, Italy. 18. UO of Clinical Oncology, Università di Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy. 19. Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy. 20. Breast Unit, ULSS3 Serenissima, Mestre, Italy. 21. Department of Plastic and Reconstructive Surgery, ULSS3 Serenissima, Mestre, Italy. 22. Breast Unit, Azienda ULSS8 Berica, Vicenza, Montecchio Maggiore, Italy. 23. Department of Plastic and Reconstructive Surgery, Medico University of Rome, Campus Bio, Rome, Italy. 24. Department of Plastic and Reconstructive Surgery, Belcolle Hospital, Viterbo, Italy. 25. Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 26. Department of Plastic and Reconstructive Hand Surgery, AOU Ospedali Riuniti di Ancona, Ancona, Italy. 27. Regenerative Surgery Research and Formation Center, Accademia del Lipofilling, Montelabbate, Italy. 28. Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy. 29. Breast Surgery Unit, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. 30. Breast Surgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy. 31. UO of Medical Oncology, Department of Oncology and Hematology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy. 32. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Abstract
BACKGROUND: Autologous fat grafting (AFG), defined as the re-implant to the breast of fat tissue from different body areas, has been firstly applied to esthetic plastic surgery and then has moved to reconstructive surgery, mainly used for scar correction and opposite breast altering. Nevertheless, due to the potentially unsafe stem-like properties of adipocytes at the tumoral bed level, no clear evidence of the procedure's oncological safety has been clearly documented at present. PATIENTS AND METHODS: We retrospectively collected data of early breast cancer (BC) patients from 17 Italian Breast Units and assessed differences in terms of locoregional recurrence rate (LRR) and locoregional recurrence-free survival (LRFS) between patients who underwent AFG and patients who did not. Differences were analyzed in the entire cohort of invasive tumors and in different subgroups, according to prognostic biological subtypes. RESULTS: With a median follow-up time of 60 months, LRR was 5.3% (n = 71) in the matched population, 3.9% (n = 18) in the AFG group, and 6.1% (n = 53) in the non-AFG group, suggesting non-inferiority of AFG (p = 0.084). Building Kaplan-Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR 0.73, 95% CI 0.41-1.30, p = 0.291). The same effect, in terms of LRFS, was also documented among different biological subtypes (luminal-like group, aHR 0.76, 95% CI 0.34-1.68, p = 0.493; HER2 enriched-like, aHR 0.89, 95% CI 0.19-4.22, p = 0.882; and TNBC, aHR 0.61, 95% CI 0.12-2.98, p = 0.543). CONCLUSIONS: Our study confirms in a very large, multicenter cohort of early BC patients that, aside the well-known benefits on the esthetic result, AFG do not interfere negatively with cancer prognosis.
BACKGROUND: Autologous fat grafting (AFG), defined as the re-implant to the breast of fat tissue from different body areas, has been firstly applied to esthetic plastic surgery and then has moved to reconstructive surgery, mainly used for scar correction and opposite breast altering. Nevertheless, due to the potentially unsafe stem-like properties of adipocytes at the tumoral bed level, no clear evidence of the procedure's oncological safety has been clearly documented at present. PATIENTS AND METHODS: We retrospectively collected data of early breast cancer (BC) patients from 17 Italian Breast Units and assessed differences in terms of locoregional recurrence rate (LRR) and locoregional recurrence-free survival (LRFS) between patients who underwent AFG and patients who did not. Differences were analyzed in the entire cohort of invasive tumors and in different subgroups, according to prognostic biological subtypes. RESULTS: With a median follow-up time of 60 months, LRR was 5.3% (n = 71) in the matched population, 3.9% (n = 18) in the AFG group, and 6.1% (n = 53) in the non-AFG group, suggesting non-inferiority of AFG (p = 0.084). Building Kaplan-Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR 0.73, 95% CI 0.41-1.30, p = 0.291). The same effect, in terms of LRFS, was also documented among different biological subtypes (luminal-like group, aHR 0.76, 95% CI 0.34-1.68, p = 0.493; HER2 enriched-like, aHR 0.89, 95% CI 0.19-4.22, p = 0.882; and TNBC, aHR 0.61, 95% CI 0.12-2.98, p = 0.543). CONCLUSIONS: Our study confirms in a very large, multicenter cohort of early BC patients that, aside the well-known benefits on the esthetic result, AFG do not interfere negatively with cancer prognosis.