Departement of Surgical Oncology, Institut Universitaire Du Cancer Toulouse Oncopole, Toulouse, France.
Departement of Surgical Oncology, Institut Universitaire Du Cancer Toulouse Oncopole, Toulouse, France.
Eur J Surg Oncol. 2024 Apr;50(4):107998. doi: 10.1016/j.ejso.2024.107998. Epub 2024 Feb 15.
Autologous fat transfer (AFT) is widely used to improve results of breast reconstructive surgery, but its safety is controversial. Our objective was to evaluate the oncologic safety of AFT in a homogeneous population of patients who underwent a total mastectomy with immediate reconstruction for breast cancer.
We performed a retrospective cohort study by identifying all patients who underwent immediate breast reconstruction after mastectomy for breast cancer from 2007 to 2015 in our center. A patient group with AFT performed in the 24 months after mastectomy was compared to a control group.
Five hundred fifty cases were included, of whom 136 (24.7%) underwent at least one fat graft transfer. Median age was 51 years. Reconstruction was performed in 465 (84.5%) with an implant reconstruction. The median time from mastectomy to AFT was 13.8 months. The median follow up was 55.2 months. A total of 53 events were observed, including 10 (7.4%) in the AFT group and 43 (10.4%) in the control group. There was no difference in 5-year recurrence-free survival (RFS) between the groups. In the subgroup analysis, only lymph node involvement in patients who underwent AFT in the first 24 months after oncologic surgery appeared as a risk factor of recurrence. Among the 104 patients with lymph node involvement, 5-year RFS was 69.2% in patients with lipofilling vs 92.5% in patients without it (p = 0 0.0351).
Performing early lipofilling in primary breast reconstruction after mastectomy for cancer seems to be oncologically safe. Lymph node involvement increases the risk of recurrence in this population.
自体脂肪移植（AFT）广泛用于改善乳房重建手术的效果，但它的安全性存在争议。我们的目的是评估在接受乳腺癌全乳切除术即刻重建的同质患者人群中，AFT 的肿瘤安全性。
我们通过在我们中心确定所有在 2007 年至 2015 年间接受全乳切除术即刻乳房重建的乳腺癌患者，进行了一项回顾性队列研究。将在全乳切除术后 24 个月内进行 AFT 的患者组与对照组进行比较。
共纳入 550 例病例，其中 136 例（24.7%）至少进行了一次脂肪移植。中位年龄为 51 岁。465 例（84.5%）进行了植入物重建。从全乳切除术到 AFT 的中位时间为 13.8 个月。中位随访时间为 55.2 个月。共观察到 53 例事件，其中 AFT 组 10 例（7.4%），对照组 43 例（10.4%）。两组 5 年无复发生存率（RFS）无差异。亚组分析显示，仅在肿瘤手术后前 24 个月接受 AFT 的患者的淋巴结受累是复发的危险因素。在 104 例淋巴结受累患者中，脂肪填充患者的 5 年 RFS 为 69.2%，无脂肪填充患者为 92.5%（p=0.0351）。
在乳腺癌全乳切除术即刻重建后早期进行脂肪填充似乎在肿瘤学上是安全的。淋巴结受累增加了该人群复发的风险。
