Meta-Analysis of the Oncological Safety of Autologous Fat Grafting After Breast Cancer on Basic Science and Clinical Studies

Stem-Cell-Assisted Lipotransfer and Platelet-Rich Plasma in Breast Reconstruction: A Literature Review

BACKGROUND

Autologous fat transplantation to the breast, a minimal invasive technique, has significantly expanded in aesthetic and reconstructive surgery over the past two decades. Initially used for lumpectomy defects or correcting contour deformities post-breast reconstruction, it is now also performed as a stand-alone technique for primary breast augmentation or as a complementary method to implant-based augmentation. However, this surgical technique is associated with a high absorption rate. The use of fat grafts for breast augmentation remains controversial due to concerns about its safety, efficacy, and impact on breast cancer.

METHODS

This review examines the literature on cell-assisted lipotransfer (CAL) and PRP-assisted lipotransfer, comparing fat graft survival, complication rates, and oncological safety with conventional autologous lipotransfer.

RESULTS

CAL and PRP-assisted lipotransfer techniques demonstrate improved fat graft retention and reduced complications compared to conventional methods. Several studies report a potential reduction in the absorption rate of fat grafts with improvements in aesthetic outcomes.

CONCLUSIONS

While CAL and PRP-assisted lipotransfer have shown promising results in enhancing fat graft survival and reducing complications, there are still concerns about their oncological safety.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Letter on: "Meta-analysis of the Oncological Safety of Autologous Fat Grafting After Breast Cancer on Basic Science and Clinical Studies"

Authors comment on the paper "Meta-analysis of the oncological safety of autologous fat grafting after breast cancer on basic science and clinical studies" written by Kai Wang et al in Aesthetic Plastic Surgery. Although the authors present interesting results on the safety of autologous fat graft after breast cancer and breast reconstruction, we express some considerations about the analyzed manuscript and about the safety of this procedure in specific cohort of patients having particular cancer characteristics.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 https://www.springer.com/00266 .

Proliferation Patterns of MCF-7 Breast Cancer Cells in Lipoaspirate Conditioned Media

INTRODUCTION

Autologous fat grafting (AFG) is a common technique used to enhance aesthetic outcomes in postmastectomy breast reconstruction patients. Adipokines are hormones secreted by adipose tissue that play a critical role in regulating metabolic processes and the immune system. However, dysregulated adipokine secretion and signaling can contribute to the development and progression of cancer by promoting angiogenesis, altering the immune response, and inducing the epithelial mesenchymal transition. We aimed to assess how breast cancer cells behave in conditioned media derived from fat grafting lipoaspirates and gain a better understanding of the potential interactions that may occur within the tumor microenvironment.

METHODS

Patients who were undergoing AFG as a part of breast reconstruction at NY-Presbyterian/Weill Cornell Medical Center between March 2021 and July 2023 were consented and enrolled in the study. This study was approved by the Weill Cornell Medicine Institutional Review Board (#20-10022850-14). Conditioned media is created using 20% of patient lipoaspirate secretome and 80% starving media. The growth of MCF-7, a human ER/PR+ breast cancer cell line, in conditioned media is assessed using CyQUANT.

RESULTS

The breast cancer cells incubated in conditioned media displayed similar growth trends as those in complete media, which is enriched for cell growth (P > 0.05). MCF-7 cell behavior in conditioned media differed significantly from their proliferation patterns when serum starved in 100% starving media (P < 0.05).

DISCUSSION

Our results suggest that there may be inherent factors within the lipoaspirate that may promote MCF-7 proliferation. One potential implication is that AFG used for breast reconstruction should be delayed until local-regional disease control has been established. In addition, based on the in vitro proliferation patterns of breast cancer cells in conditioned media, the safety profile of AFG may be enhanced if the procedure is performed after attaining negative margins and the completion breast cancer treatment.