EC Gynaecology

Aim: To provide an overview of lipofilling as a reconstructive option post-mastectomy in breast cancer patients, addressing its adverse events, recurrence rates, and the importance of ongoing vigilance through standardized screening.

Introduction and Conclusion: Breast cancer, the most common cancer in women, benefits from improved detection through screening programs. Lipofilling, an autologous grafting technique, has emerged as a post-mastectomy reconstructive option. This review focuses on lipofilling, addressing its technique, adverse events, and recurrence rates in breast cancer patients. Success depends on careful injection consideration to limit damage to physiological structures. Adverse events, such as fat necrosis and microcalcifications, pose risks, potentially increasing malignancy risk. Lipofilling after oncoplastic surgery exhibits low recurrence rates without evident escalation in locoregional or distant reoccurrence risks. Despite favorable outcomes, radiological observations mandate ongoing vigilance and adherence to standardized screening. A balanced understanding of these factors is crucial for optimizing care in breast cancer survivors choosing lipofilling for reconstruction.

 Keywords: Lipofilling; Breast Cancer; Calcification; Radiological Imaging; Recurrence

1. Mayrovitz HN. “Breast cancer”. Exon Publications. Copyright© 2022 Exon Publications (2022).
2. Czajka ML and Pfeifer C. “Breast cancer surgery”. StatPearls. StatPearls Publishing. Copyright © 2023, StatPearls Publishing LLC (2023).
3. Kasem A., et al. “Breast lipofilling: a review of current practice”. Archives of Plastic Surgery2 (2015): 126-130.
4. Largo RD., et al. “Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: a systematic review”. Journal of Plastic, Reconstructive and Aesthetic Surgery4 (2014): 437-448.
5. Carloni R., et al. “Preoperative imaging prior to breast reconstruction surgery: benchmarking bringing together radiologists and plastic surgeons. Proposed guidelines”. Annales de Chirurgie Plastique Esthétique 2 (2014): e13-e19.
6. Berg WA. “Reducing unnecessary biopsy and follow-up of benign cystic breast lesions”. Radiology1 (2020): 52-53.
7. Agostini T., et al. “Wet and dry techniques for structural fat graft harvesting: histomorphometric and cell viability assessments of lipoaspirated samples”. Plastic and Reconstructive Surgery 2 (2012): 331e-339e.
8. Lee JH., et al. “The effect of pressure and shear on autologous fat grafting”. Plastic and Reconstructive Surgery 5 (2013): 1125-1136.
9. Xue EY., et al. “Fat processing techniques”. Seminars in Plastic Surgery 1 (2020): 11-16.
10. Trojahn Kølle SF., et al. “Importance of mesenchymal stem cells in autologous fat grafting: a systematic review of existing studies”. Journal of Plastic Surgery and Hand Surgery 2 (2012): 59-68.
11. Noor L., et al. “Imaging changes after breast reconstruction with fat grafting - Retrospective study of 90 breast cancer”. Pakistan Journal of Medical Sciences 1 (2016): 8-12.
12. Molière S., et al. “[Lipofilling in the management of breast cancer: An update based on a literature review and national and international guidelines]”. Gynécologie Obstétrique Fertilité & Sénologie 10 (2023): 471-480.
13. Silva-Vergara C., et al. “Oncological outcomes of lipofilling breast reconstruction: 195 consecutive cases and literature review”. Journal of Plastic, Reconstructive and Aesthetic Surgery 4 (2016): 475-481.
14. Piffer A., et al. “Breast reconstruction by exclusive lipofilling after total mastectomy for breast cancer: description of the technique and evaluation of quality of life”. Journal of Personalized Medicine 2 (2022): 153.
15. Riggio E., et al. “Oncologic surveillance of breast cancer patients after lipofilling”. Aesthetic Plastic Surgery 4 (2013): 728-735.
16. Osswald R., et al. “Does lipofilling after oncologic breast surgery increase the amount of suspicious imaging and required biopsies?-A systematic meta-analysis”. Breast Journal 5 (2020): 847-859.
17. Petit JY., et al. “Evaluation of fat grafting safety in patients with intraepithelial neoplasia: a matched-cohort study”. Annals of Oncology 6 (2013): 1479-1484.
18. Veber M., et al. “Radiographic findings after breast augmentation by autologous fat transfer”. Plastic and Reconstructive Surgery3 (2011): 1289-1299.
19. Wang C-F., et al. “Clinical analyses of clustered microcalcifications after autologous fat injection for breast augmentation”. Plastic and Reconstructive Surgery4 (2011): 1669-1673.
20. Lagumdzija J and Wechselberger G. “Unknown case: linear distribution of calcifications in a patient presenting for elective aesthetic surgery”. Journal of Breast Imaging 6 (2023): 744-745.
21. Costantini M., et al. “Radiological findings in mammary autologous fat injections: a multi-technique evaluation”. Clinical Radiology 1 (2013): 27-33.
22. Gosset J., et al. “[Radiological evaluation after lipomodelling for correction of breast conservative treatment sequelae]”. Annales de Chirurgie Plastique Esthétique 2 (2008): 178-189.
23. Rubin J., et al. “Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study”. Plastic and Reconstructive Surgery5 (2012): 1029-1038.
24. Atia AA., et al. “Clinical and radiological assessment of autologous fat transfer to the breast”. European Journal of Plastic Surgery2 (2020): 139-146.
25. Jeitler K., et al. “[Breast cancer screening in Austria: Key figures, age limits, screening intervals and evidence]”. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 4-5 (2015): 363-370.