Introduction: The clinical surveillance of a patient treated for breast cancer involves many specialists: a surgeon, an oncologist, a radiotherapist, a gynecologist, and a general practitioner. The patients diagnosed with breast cancer will require regular clinical examination in order to identify possible recurrences. In our team, fat grafting has been used since 1998 for breast reconstruction because its results are natural breasts. Usually used as an adjuvant for flap or implant breast reconstruction, the lipofilling increases the aesthetic result and has a high satisfaction rate among patients. Despite of this advantage, some teams do not use lipofilling in patients with breast cancer history, because of doubts about oncology safety and screening difficulty. We performed an extensive review of the literature available regarding this subject. The purpose of this article is to evaluate the oncology safety of lipofilling in breast reconstruction after breast cancer.
Material and method: A literature review was undertaken using PubMed. The key words searched were: breast lipofilling, breast reconstruction, breast cancer, and recurrence.
Results: The results of the literature review showed a reduced number of articles reporting recurrence after lipofilling. The retrospective studies included few patients and searched for multiple variables: histological type, stage, surgery, marginal invasion, distance between cancer surgery and lipofilling. In our research, we found no correct control group, except the series of Petit. The follow-up is relatively short (between 1 and 3years), except for the series of Rigotti. The recurrence cases after lipofilling in patients with extensive in situ carcinoma, in the series of Petit, raised the problem to be cautious with lipofilling after extensive in situ carcinoma. Other factors involved are the age of the patient and the distance between the cancer surgery and the lipofilling.
Conclusion: Breast cancer is a disease that is well managed regarding treatment and follow-up. After reviewing the available literature, we consider that the lipofilling does not have a negative impact on the recurrence of breast cancer. There are however several precautions that must be taken into account in the sequelae of the conservative treatment (image exam before and after surgery, 3years delay of the procedure after the oncology treatment) and in the extensive in situ carcinoma. For this particular case of breast reconstruction using lipofilling, a multidisciplinary discussion of the reconstruction options might be a reasonable approach. It is important that the patients treated for breast cancer continue a clinical and imaging exam regardless of the breast reconstruction method, in order to identify a possible relapse as early as possible.
Keywords: Breast conservative surgery; Breast reconstruction; Cancer; Fat grafting; Lipofilling; Reconstruction mammaire; Recurrence; Récidive; Séquelles de traitement conservateur; Transfert graisseux.
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