Thursday, March 31, 2011

Fat Grafting to the Breast and Oncologic Risks

Fat grafting to the breast has become an acceptable practice.  It is being used to repair small defects as well as to augment.  As I noted in my post (November 22, 2010), the two articles (2nd and 3rd references below) from researchers at the University of Pittsburgh School of Medicine suggests that it is NOT safe to use adipose-derived stem cells (ADSC) that may be part of fat grafting in any patient with active tumor cells.

This new article (first reference below) discusses potential risks of current and novel approaches to autologous fat grafting to the breast within the context of both the underlying science and clinical practice.  They conclude (bold emphasis is mine):

There are theoretical reasons why fat grafting might influence breast cancer growth or metastasis. Certain laboratory studies can be interpreted as supporting their negative impact on tumor development, metastasis, or recurrence. However, careful review of these concerns suggests that they arise from factors and situations that are not present to a significant extent in the clinical setting.

A study that approximates more closely the clinical situation of fat grafting into the breast has been presented in poster form.   This study investigated an orthotopic model of breast cancer in which human breast cancer cells were implanted into the mammary fat pad of immunodeficient animals, followed by placement of a human fat graft (with or without noncultured supplemental cells) immediately adjacent to the mammary fat pad containing the nascent tumor. The study found no increase in tumor growth with either an estrogen receptor-positive or an estrogen receptor-negative human breast cancer line. This is consistent with the absence of evidence for increased cancer risk in the many reports of fat grafting for breast reconstruction and augmentation. However, at this time, the number of patients with prolonged follow-up is only approximately 1000 and appropriate caution in proceeding is indicated.

……….In the clinical setting, several studies note the importance of good communication between the surgeon and an experienced radiologist to ensure accurate interpretation of breast imaging findings. Incorporation of these steps into good clinical practice and timely reporting of outcome data, including long-term follow-up—preferably in the form of multi-center clinical studies or a robust international patient registry—will ensure that the field develops in a safe and appropriate manner.

 

 

 

 

REFERENCES

1.  Oncologic Risks of Autologous Fat Grafting to the Breast; Fraser JK,  Hedrick MH, Cohen SR;  Aesthetic Surgery Journal January 2011 31: 68-75, doi:10.1177/1090820X10390922

2.  Regenerative Therapy and Cancer: In Vitro and In Vivo Studies of the Interaction Between Adipose-Derived Stem Cells and Breast Cancer Cells from Clinical Isolates; Ludovic Zimmerlin, Albert D. Donnenberg, J. Peter Rubin, Per Basse, Rodney J. Landreneau, Vera S. Donnenberg; Tissue Engineering Part A. September 2010, ahead of print.

3.  Regenerative Therapy After Cancer: What Are the Risks?; Vera S. Donnenberg, Ludovic Zimmerlin, Joseph Peter Rubin, Albert D. Donnenberg; Tissue Engineering Part B: Reviews. November 2010, ahead of print.

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