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

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.