Breast reconstruction is included in the treatment plans for each individual breast cancer patient to improve quality of life.¹–⁴ To obtain satisfactory results, surgeons focus on cosmetic issues and, even more importantly, on oncologic safety.⁵ Despite various
techniques of reconstruction with autologous tissues or prostheses, adipocyte tissue has been used more frequently in the recent era.⁶–⁹ The indications for lipofilling include micromastia, tuberous breasts, Poland syndrome, postlumpectomy deformity, postmastectomy deformity, sequelae of postradiotherapy, secondary reconstruction after flap or prosthesis reconstruction, and nipple reconstruction.¹⁰–¹³

Recently, a number of new techniques of fat preparation have been described, with the ultimate goal of improving adipocyte purification and stem cell selection.¹⁴–¹⁶ However, many fundamental studies have suggested that adipocytes and preadipocytes and their products are involved in the tumor cell cycle through autocrine, paracrine, and exocrine/endocrine secretions.¹⁷,¹⁸ Such secretions delivered on tumor sites may play a role in tumorigenesis, tumor progression, and tumor recurrence or metastasis. In contrast, some of them could have an inhibitory effect on some particular stages of the tumor cycle. Breast cancer cells might still be present in the residual mammary parenchyma after conservative treatment or in the subcutaneous tissue after mastectomy. Therefore, based on these contradictory studies, a highly relevant clinical question is whether the lipofilling technique is a safe procedure after breast cancer treatment, especially in breast-conserving protocols.¹⁹–²⁴

The review article by Lohsiriwat et al.²⁵ on experimental studies found that adipocyte, preadipocyte, and progenitor cell secretions can stimulate angiogenesis and cell growth. They also emphasized that the “tumor-stroma interaction” can potentially induce cancer reappearance by “fueling” dormant breast cancer cells in the tumor bed. However, there is a lack of translational research that proves this concern clinically. No study on the effects of lipotransfer on human cancer breast cells in vivo is available. The direct and indirect effects of lipotransfer in breast cancer patients, highlighting pro and con–related issues, remain unclear. Today, no informed consent can be given to our patients stating that lipofilling does not stimulate fueling of dormant cancer cells or eventually induce new cancer cells.²⁶

There is no international agreement for lipofilling after breast cancer treatment. Depending on country, the safety of lipofilling is still a controversial issue. In 2007, the French Society of Plastic Reconstructive and Aesthetic Surgery (Société Française de Chirurgie Plastique Reconstructrice et Esthétique) addressed the question of cancer safety for lipofilling technique in breast cancer patients.²⁷ The Society sent a “recommendation to the French plastic surgeons to postpone the lipofilling in the breast with or without breast cancer history unless it is performed under prospective controlled protocol.” In 2009, the American Society of Plastic Surgeons Fat Graft Task Force concluded that no reliable studies can confirm definitely the oncologic safety of lipofilling in breast cancer patients.¹³ The Italian Society of Plastic Surgery in 2010 advised surgeons to perform lipofilling with caution and with a precise consent form but did not impose any restrictions regarding lipotransfer indications. Our purpose was to design a multicenter observational study on lipofilling after breast cancer with a significant number of cases to check the complication rate of the technique, the risk of modification of mammography and ultrasound, and the occurrence of a suspicious image, and to record oncologic follow-up.