Palpable Nodules After Autologous Fat Grafting in Breast Cancer Patients: Incidence and Impact on Follow-up

Overview

Journal Aesthetic Plast Surg

Specialty General Surgery

Date 2021 Aug 26

PMID 34435220

Citations 3

Authors

Pauline Dile

Karine Hannebicque

Celine Renaudeau

Emilie Bogart

Luc Ceugnart

Claudia Regis

Loic Boulanger

Marie-Pierre Chauvet

Affiliations

Soon will be listed here.

Abstract

Introduction: Autologous fat grafting (AFG) is a promising breast reconstruction technique, following surgery. However, fat necrosis after AFG can cause palpable nodules, inducing anxiety and prompting additional investigations. We aimed to determine the occurrence rate and to identify the risk factors of palpable nodules in breast cancer patients prompting complementary explorations.

Materials And Methods: We retrospectively reviewed the computerized files of consecutive breast cancer patients who underwent AFG after mastectomy or breast conservative treatment (BCT) at our center from January 2013 to December 2016. We collected data regarding palpable nodule incidences and suspicious breast imaging findings that led to additional explorations.

Results: Of the 252 patients reviewed, 222 (88%) underwent AFG for breast reconstruction, while 30 (12%) underwent AFG for correction of defects after BCT. The follow-up period ranged from 0 to 74 months (median: 27 months), and 201 patients had follow-ups beyond 1 year. Of the 252 patients, 66 (26.2%) underwent at least one control imaging and 24 (10%) underwent a biopsy, including 6 (2.4%) locoregional recurrence. Sixty patients (24%) were diagnosed with nodules during follow-ups. Among them, 52 (87%) patients had additional imaging, and 17 patients (28%) had a biopsy, including 82% benign histology. Patients with BCT had significantly more palpable nodules at 1 year than patients who underwent total mastectomy (odds ratio = 2.50, 95% confidence interval: 1.04. 6.03, p = 0.04).

Conclusion: This study underlines the importance of preoperative patient information. This intervention and its follow-up should be reserved for experienced teams to limit unnecessary additional explorations.

Level Of Evidence Iv: 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 .

Citing Articles

Radiologic findings in women after Autologous Fat Transfer (AFT) based breast reconstruction: A Systematic Review.

Rijkx M, Bernardi E, Schop S, Heuts E, Lobbes M, Hommes J JPRAS Open. 2024; 42:113-132.

PMID: 39308743 PMC: 11416601. DOI: 10.1016/j.jpra.2024.08.002.

Autologous Fat Grafting (AFG): A Systematic Review to Evaluate Oncological Safety in Breast Cancer Patients.

Lo Torto F, Patane L, Abbaticchio D, Pagnotta A, Ribuffo D J Clin Med. 2024; 13(15).

PMID: 39124636 PMC: 11313166. DOI: 10.3390/jcm13154369.

Invited Discussion on: Palpable Nodules after Autologous Fat Grafting in Breast Cancer Patients: Incidence and Impact on Follow-up.

Rubin J, Robinson B Aesthetic Plast Surg. 2023; 47(2):512-514.

PMID: 36764934 PMC: 11232029. DOI: 10.1007/s00266-021-02748-9.

References

Chan C, McCulley S, Macmillan R . Autologous fat transfer--a review of the literature with a focus on breast cancer surgery. J Plast Reconstr Aesthet Surg. 2008; 61(12):1438-48. DOI: 10.1016/j.bjps.2008.08.006. View

Khouri R, Eisenmann-Klein M, Cardoso E, Cooley B, Kacher D, Gombos E . Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study. Plast Reconstr Surg. 2012; 129(5):1173-1187. DOI: 10.1097/PRS.0b013e31824a2db6. View

Gale K, Rakha E, Ball G, Tan V, McCulley S, Macmillan R . A case-controlled study of the oncologic safety of fat grafting. Plast Reconstr Surg. 2015; 135(5):1263-1275. DOI: 10.1097/PRS.0000000000001151. View

Kronowitz S, Mandujano C, Liu J, Kuerer H, Smith B, Garvey P . Lipofilling of the Breast Does Not Increase the Risk of Recurrence of Breast Cancer: A Matched Controlled Study. Plast Reconstr Surg. 2016; 137(2):385-393. DOI: 10.1097/01.prs.0000475741.32563.50. View

Petit J, Maisonneuve P, Rotmensz N, Bertolini F, Rietjens M . Fat Grafting after Invasive Breast Cancer: A Matched Case-Control Study. Plast Reconstr Surg. 2017; 139(6):1292-1296. DOI: 10.1097/PRS.0000000000003339. View

Coleman S . Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg. 1995; 19(5):421-5. DOI: 10.1007/BF00453875. View

Groen J, Negenborn V, Twisk D, Rizopoulos D, Ket J, Smit J . Autologous fat grafting in onco-plastic breast reconstruction: A systematic review on oncological and radiological safety, complications, volume retention and patient/surgeon satisfaction. J Plast Reconstr Aesthet Surg. 2016; 69(6):742-764. DOI: 10.1016/j.bjps.2016.03.019. View

de Blacam C, Momoh A, Colakoglu S, Tobias A, Lee B . Evaluation of clinical outcomes and aesthetic results after autologous fat grafting for contour deformities of the reconstructed breast. Plast Reconstr Surg. 2011; 128(5):411e-418e. DOI: 10.1097/PRS.0b013e31822b669f. View

Molto Garcia R, Gonzalez Alonso V, Villaverde Domenech M . Fat grafting in immediate breast reconstruction. Avoiding breast sequelae. Breast Cancer. 2014; 23(1):134-140. DOI: 10.1007/s12282-014-0541-3. View

10.

Claro Jr F, Figueiredo J, Zampar A, Pinto-Neto A . Applicability and safety of autologous fat for reconstruction of the breast. Br J Surg. 2012; 99(6):768-80. DOI: 10.1002/bjs.8722. View

11.

Stark R, Mirzabeigi M, VonderHaar R, Bucky L . Utilizing large volume fat grafting in breast reconstruction after nipple sparing mastectomies. Gland Surg. 2018; 7(3):337-346. PMC: 6006019. DOI: 10.21037/gs.2018.05.01. View

12.

Pulagam S, Poulton T, Mamounas E . Long-term clinical and radiologic results with autologous fat transplantation for breast augmentation: case reports and review of the literature. Breast J. 2006; 12(1):63-5. DOI: 10.1111/j.1075-122X.2006.00188.x. View

13.

Brenelli F, Rietjens M, De Lorenzi F, Pinto-Neto A, Rossetto F, Martella S . Oncological safety of autologous fat grafting after breast conservative treatment: a prospective evaluation. Breast J. 2014; 20(2):159-65. DOI: 10.1111/tbj.12225. View

14.

Rietjens M, De Lorenzi F, Rossetto F, Brenelli F, Manconi A, Martella S . Safety of fat grafting in secondary breast reconstruction after cancer. J Plast Reconstr Aesthet Surg. 2010; 64(4):477-83. DOI: 10.1016/j.bjps.2010.06.024. View

15.

Mann R, Ballard T, Brown D, Momoh A, Wilkins E, Kozlow J . Autologous fat grafting to lumpectomy defects: complications, imaging, and biopsy rates. J Surg Res. 2018; 231:316-322. DOI: 10.1016/j.jss.2018.05.023. View

16.

Coleman S, Saboeiro A . Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg. 2007; 119(3):775-85. DOI: 10.1097/01.prs.0000252001.59162.c9. View

17.

Delay E, Gosset J, Toussoun G, Delaporte T, Delbaere M . [Efficacy of lipomodelling for the management of sequelae of breast cancer conservative treatment]. Ann Chir Plast Esthet. 2007; 53(2):153-68. DOI: 10.1016/j.anplas.2007.09.005. View

18.

Delay E, Delpierre J, Sinna R, Chekaroua K . [How to improve breast implant reconstructions?]. Ann Chir Plast Esthet. 2005; 50(5):582-94. DOI: 10.1016/j.anplas.2005.08.008. View

19.

Missana M, Laurent I, Barreau L, Balleyguier C . Autologous fat transfer in reconstructive breast surgery: indications, technique and results. Eur J Surg Oncol. 2007; 33(6):685-90. DOI: 10.1016/j.ejso.2006.12.002. View

20.

Delay E, Savu T, Atanasiu M . [Lipomodeling in breast reconstruction]. Ann Chir Plast Esthet. 2018; 63(5-6):505-515. DOI: 10.1016/j.anplas.2018.06.012. View