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Lani · 06-07-2014, 06:47 PM

Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 67, Issue 5, May 2014, Pages e127–e128

Cover image
Correspondence and communication
Recurrence of invasive ductal breast carcinoma 10 months after autologous fat grafting
J.M. Smit, H.J.P. Tielemans
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DOI: 10.1016/j.bjps.2013.12.043
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Referred to by
B. Chaput, J.L. Grolleau, N. Bertheuil, H. Eburdery, J.P. Chavoin, I. Garrido
Another suspected case of breast cancer recurrence after lipofilling? Remain cautious …
Journal of Plastic, Reconstructive & Aesthetic Surgery, Available online 28 March 2014,
PDF (139 K)
Dear Sir,
Lipofilling has been carried out in aesthetic surgery worldwide for many years and, more recently, in breast cancer patients to improve the results of breast reconstruction.1 and 2 While numerous published clinical studies have highlighted the advantages of this procedure, it remains of importance to be aware that it might also have potential down sides. With this in mind we like to report the following case.

It concerned a 44-year old female who had undergone a right modified radical mastectomy due to grade II invasive ductal carcinoma followed by radiotherapy in 2006. In 2009 the same surgical procedure was performed on her left side, followed again by radiotherapy, because of a lymphangitis carcinomatosa. In both cases she received neo-adjuvant chemotherapy. In that same year, a BRCA2 gene mutation was diagnosed. In 2011, she first came to our department because of pain and tightness of both her mastectomy scars for which lipofilling was proposed. In one year time she underwent two lipofilling sessions in which in total 150 cc fat was injected per side. This reduced her complaints.

In 2013 she returned to our outpatient clinic due to a skin rash around her right mastectomy scar. Biopsies showed a recurrence of the invasive ductal carcinoma for which surgery was indicated. Despite a margin of 2 cm and a partial resection of the pectoralis major muscle, the resection was incomplete and re-excision had to be performed. Radical resection of the tumour was achieved during a second procedure. The remaining defect was closed with a latissimus dorsi flap.

On histological analysis we observed invasive ductal carcinoma with extensive lymph angioinvasive growth and numerous tumour nests embedded in sclerotic stroma and often associated with subcutaneous (remnants of) fat necrosis, in particular oil cysts (Figure 1). Although it is not uncommon to see scleroplastic stroma around tumour nests, it is to see fat necrosis and oil cysts.

Full-size image (56 K)
Figure 1.
Histologic analysis of the mastectomy scar showed extensive and multifocal tumorrecurrence. This representative photograph (hematoxylin and eosin, x50) demonstrates subcutaneous tumordepositis (encircled) associated with subcutaneous remnants of fat necrosis, in particular oil cysts (*).
Figure options
In 2013, a similar case has been reported by Chaput et al.3 In their histological report they described tumour cells in trenches created by autologous fat grafting lipofilling. As in our case, it concerned an aggressive tumour that required multiple treatments.

With reporting these cases, it is not our aim try to suggest a direct causal link between lipofilling and the recurrence of breast cancer, but want to discuss the possibility of a synchronous recurrence to autologous fat grafting that may have been masked. Nonetheless, the risks of promoting a latent cancer or metastases are not excluded, especially when taking these histological findings in consideration.

It is our opinion is that lipofilling offers many advantages in breast reconstruction and the cosmetic refinements afterwards, but controversy remains.4 Until the first outcomes are reported of the large prospective multicentre studies currently in progress about autologous fat grafting in breast cancer patients, these points will however remain open for discussion.

Conflict of interest
None.

Funding
None.

References
1
J.Y. Petit, V. Lohsiriwat, K.B. Clough et al.
The oncologic outcome and immediate surgical complications of lipofilling in breast cancer patients: a multicenter study —Milan–Paris–Lyon experience of 646 lipofilling procedures
Plast Reconstr Surg, 128 (2011), pp. 341–346

View Record in Scopus | Full Text via CrossRef | Citing articles (1)
2
M. Rietjens, F. De Lorenzi, F. Rossetto et al.
Safety of fat grafting in secondary breast reconstruction after cancer
J Plast Reconstr Aesthet Surg, 64 (2011), pp. 477–483

Article | PDF (389 K)
3
B. Chaput, L. Foucras, S. Le Guellec, J.L. Grolleau, I. Garrido
Recurrence of an invasive ductal breast carcinoma 4 months after autologous fat grafting
Plast Reconstr Surg, 131 (2013), pp. 123e–124e

Full Text via CrossRef
4
J.Y. Petit, M. Rietjens, E. Botteri et al.
Evaluation of fat grafting safety in patients with intra epithelial neoplasia: a matched-cohort study
Ann Oncol, 24 (6) (2013), pp. 1479–1484

View Record in Scopus | Full Text via CrossRef | Citing articles (7)
Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

06-07-2014, 06:47 PM	#6
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	Re: Fat Grafting Journal of Plastic, Reconstructive & Aesthetic Surgery Volume 67, Issue 5, May 2014, Pages e127–e128 Cover image Correspondence and communication Recurrence of invasive ductal breast carcinoma 10 months after autologous fat grafting J.M. Smit, H.J.P. Tielemans Show more DOI: 10.1016/j.bjps.2013.12.043 Get rights and content Referred to by B. Chaput, J.L. Grolleau, N. Bertheuil, H. Eburdery, J.P. Chavoin, I. Garrido Another suspected case of breast cancer recurrence after lipofilling? Remain cautious … Journal of Plastic, Reconstructive & Aesthetic Surgery, Available online 28 March 2014, PDF (139 K) Dear Sir, Lipofilling has been carried out in aesthetic surgery worldwide for many years and, more recently, in breast cancer patients to improve the results of breast reconstruction.1 and 2 While numerous published clinical studies have highlighted the advantages of this procedure, it remains of importance to be aware that it might also have potential down sides. With this in mind we like to report the following case. It concerned a 44-year old female who had undergone a right modified radical mastectomy due to grade II invasive ductal carcinoma followed by radiotherapy in 2006. In 2009 the same surgical procedure was performed on her left side, followed again by radiotherapy, because of a lymphangitis carcinomatosa. In both cases she received neo-adjuvant chemotherapy. In that same year, a BRCA2 gene mutation was diagnosed. In 2011, she first came to our department because of pain and tightness of both her mastectomy scars for which lipofilling was proposed. In one year time she underwent two lipofilling sessions in which in total 150 cc fat was injected per side. This reduced her complaints. In 2013 she returned to our outpatient clinic due to a skin rash around her right mastectomy scar. Biopsies showed a recurrence of the invasive ductal carcinoma for which surgery was indicated. Despite a margin of 2 cm and a partial resection of the pectoralis major muscle, the resection was incomplete and re-excision had to be performed. Radical resection of the tumour was achieved during a second procedure. The remaining defect was closed with a latissimus dorsi flap. On histological analysis we observed invasive ductal carcinoma with extensive lymph angioinvasive growth and numerous tumour nests embedded in sclerotic stroma and often associated with subcutaneous (remnants of) fat necrosis, in particular oil cysts (Figure 1). Although it is not uncommon to see scleroplastic stroma around tumour nests, it is to see fat necrosis and oil cysts. Full-size image (56 K) Figure 1. Histologic analysis of the mastectomy scar showed extensive and multifocal tumorrecurrence. This representative photograph (hematoxylin and eosin, x50) demonstrates subcutaneous tumordepositis (encircled) associated with subcutaneous remnants of fat necrosis, in particular oil cysts (*). Figure options In 2013, a similar case has been reported by Chaput et al.3 In their histological report they described tumour cells in trenches created by autologous fat grafting lipofilling. As in our case, it concerned an aggressive tumour that required multiple treatments. With reporting these cases, it is not our aim try to suggest a direct causal link between lipofilling and the recurrence of breast cancer, but want to discuss the possibility of a synchronous recurrence to autologous fat grafting that may have been masked. Nonetheless, the risks of promoting a latent cancer or metastases are not excluded, especially when taking these histological findings in consideration. It is our opinion is that lipofilling offers many advantages in breast reconstruction and the cosmetic refinements afterwards, but controversy remains.4 Until the first outcomes are reported of the large prospective multicentre studies currently in progress about autologous fat grafting in breast cancer patients, these points will however remain open for discussion. Conflict of interest None. Funding None. References 1 J.Y. Petit, V. Lohsiriwat, K.B. Clough et al. The oncologic outcome and immediate surgical complications of lipofilling in breast cancer patients: a multicenter study —Milan–Paris–Lyon experience of 646 lipofilling procedures Plast Reconstr Surg, 128 (2011), pp. 341–346 View Record in Scopus \| Full Text via CrossRef \| Citing articles (1) 2 M. Rietjens, F. De Lorenzi, F. Rossetto et al. Safety of fat grafting in secondary breast reconstruction after cancer J Plast Reconstr Aesthet Surg, 64 (2011), pp. 477–483 Article \| PDF (389 K) 3 B. Chaput, L. Foucras, S. Le Guellec, J.L. Grolleau, I. Garrido Recurrence of an invasive ductal breast carcinoma 4 months after autologous fat grafting Plast Reconstr Surg, 131 (2013), pp. 123e–124e Full Text via CrossRef 4 J.Y. Petit, M. Rietjens, E. Botteri et al. Evaluation of fat grafting safety in patients with intra epithelial neoplasia: a matched-cohort study Ann Oncol, 24 (6) (2013), pp. 1479–1484 View Record in Scopus \| Full Text via CrossRef \| Citing articles (7) Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.