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Original Investigation
January 2019

Long-term Follow-up of Autologous Fat Transfer vs Conventional Breast Reconstruction and Association With Cancer Relapse in Patients With Breast Cancer

Author Affiliations
  • 1Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
  • 2Department of Plastic, Reconstructive and Hand Surgery, Tergooi Hospital, Hilversum, the Netherlands
  • 3Department of General Surgery, Tergooi Hospital, Hilversum, Netherlands
  • 4Department of Statistics and Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands
JAMA Surg. 2019;154(1):56-63. doi:10.1001/jamasurg.2018.3744
Key Points

Question  Are patients with breast cancer treated with autologous fat transfer at an increased risk of cancer relapse compared with those who receive conventional breast reconstruction?

Findings  In this cohort study examining 300 affected breasts reconstructed with autologous fat transfer and 300 matched control patients, no significant difference in the rate of locoregional recurrence was observed after 5-year follow-up.

Meaning  Exposure to autologous fat transfer was not found to be associated with increased rates of cancer relapse, thereby confirming the short-term findings of previous studies that clinical evidence does not suggest the presence of such risks.

Abstract

Importance  Autologous fat transfer (AFT or fat grafting) has become an invaluable tool for the correction of disfiguring deformities after breast cancer surgery. However, clinical and animal studies have shown conflicting results regarding its oncologic safety.

Objective  To determine whether exposure to AFT vs conventional breast reconstruction is associated with increased rates of cancer relapse in patients with breast cancer.

Design, Setting, and Participants  This matched cohort study involved retrospective medical record review to identify all patients in a local patient database receiving AFT between 2006 and 2014. Each AFT case was matched with a nonexposed control patient with similar baseline characteristics. The mean (SD) follow-up of patients receiving AFT was 9.3 (4.9) years including 5.0 (1.7) years following AFT. Control patients were followed up for a mean (SD) of 8.6 (1.8) years from the primary surgery. Patients were identified through the local patient database of the Tergooi Hospital in Hilversum, the Netherlands. A total of 287 patients with breast cancer (300 affected breasts) who received AFT for breast reconstruction after cancer were included in the intervention group. Each AFT case was matched with a respective control patient based on age, type of oncologic surgery, tumor invasiveness, and disease stage. In addition, individual AFT-control pairs were selected to have the same locoregional recurrence–free interval at baseline. Data were analyzed between 2016 and 2017.

Exposures  Reconstruction with AFT vs conventional breast reconstruction or none.

Main Outcomes and Measures  Primary end points were the cumulative incidences of oncologic events in AFT and control patients and their respective hazard ratios.

Results  Of the 587 total patients, all were women and the mean age was 48.1 years for the patients undergoing AFT and 49.4 years for the control patients. Eight locoregional recurrences were observed in the treatment group (287 patients) and 11 among the control group (300 patients), leading to an unadjusted hazard ratio of 0.63 (95% CI, 0.25-1.60; P = .33). No increased locoregional recurrence rates were seen in relevant subgroups based on the type of oncological surgery, tumor invasiveness, or pathological stage. In addition, no increased risks with AFT were detected with respect to distant recurrences or breast cancer–specific mortality.

Conclusions and Relevance  No significant differences in the locoregional recurrence rates between the AFT and control groups were observed after 5 years of follow-up. These findings confirm the results of previous studies; therefore, clinical evidence suggesting that AFT is associated with increased risk for cancer relapse is still lacking.

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