An Animal Model of Local Breast Cancer Recurrence in the Setting of Autologous Fat Grafting for Breast Reconstruction (original) (raw)
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Interaction Between Breast Cancer Cells and Adipose Tissue Cells Derived from Fat Grafting
Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery, 2015
Adipose tissue transplantation has the benefit of providing both regenerative and aesthetic outcomes in breast cancer treatment. However, the transplanted tissue can stimulate the growth of residual cancer cells. The aim of this study is to identify the interactions between adipose tissue cell subpopulations and human cancer cell lines. Intact adipose tissue from lipofilling procedures as well as fibroblasts derived from adipose tissue, were cocultured in the presence of MDA-MB-231, MCF-7 e ZR-75-1 breast cancer cell lines. The influence on cancer cell lines of fibroblasts, induced to differentiate into specific adipocytes, was also assayed. All cancer cell lines displayed a significant increase in proliferation rate when cocultured in the presence of either intact adipose tissue or induced adipocytes. To a lesser extent, uninduced fibroblasts stimulate breast cancer cell proliferation. Recent studies have shown that the microenvironment surrounding breast cancer cells may stimulate...
Plastic & Reconstructive Surgery, 2018
Background: The authors investigate the in vitro and in vivo interaction of human breast cancer cells and human adipose-derived stem cells to address the controversy on the safety of postmastectomy fat grafting. Methods: The authors co-cultured human adipose-derived stem cells and MDA-MB-231 breast cancer cells in an in vitro cell migration assay to examine the migration of breast cancer cells. In the in vivo arm, the authors injected breast cancer cells (group I), human breast cancer cells plus human adipose-derived stem cells (group II), human breast cancer cells plus human fat graft (group III), and human breast cancer cells plus human fat graft plus human adipose-derived stem cells (group IV) to the mammary fat pads of female nude mice (n = 20). The authors examined the tumors, livers, and lungs histologically after 2 weeks. Results: Migration of breast cancer cells increased significantly when co-cultured with adipose-derived stem cells (p < 0.05). The tumor growth rate in g...
Plastic and Reconstructive Surgery, 2019
Background: Clinical outcomes suggest that post-oncologic reconstruction with fat grafting yields cumulative incidence curves of recurrence comparable to other breast reconstruction procedures, however results from experimental research studies are discordant. In this study, a novel animal model of residual cancer cells in mouse mammary pads was developed to test whether lipofilling impacts the probability of post-mastectomy locoregional recurrence of breast cancer after breast conserving surgery.
A case controlled study of the oncological safety of fat grafting
Plastic and Reconstructive Surgery, 2015
at grafting to the breast fulfills an increased clinical demand for a biocompatible filler in contour refinement, volume adjustment, and tissue rejuvenation in both cosmetic and reconstructive procedures, and has been used for total breast reconstruction. 1-5 Although many clinical studies have reported on the efficacy of fat grafting for breast cancer patients in terms of its various indications, 2,6-9 technical advancements,
Autologous Fat Grafting as a Novel Antiestrogen Vehicle for the Treatment of Breast Cancer
Plastic and Reconstructive Surgery, 2018
Background: Adipose fat transfer is increasingly used for contour corrections of the tumor bed after lumpectomy and breast reconstructions after mastectomy. The lipophilic nature of the fat tissue may render adipocytes an ideal vehicle with which to deliver a high boost of an antiestrogen to the tumor bed to serve as an adjunct systemic hormonal therapy. The authors therefore tested whether adipocytes could safely be loaded with an antiestrogen and allow for release at therapeutic concentrations to treat breast cancer. Methods: Adipose tissue was collected from patients undergoing autologous fat grafting. The influence of adipose tissue on tumorigenesis was determined both in vitro and in vivo using breast cancer cell lines. Ex vivo, adipose tissue was assessed for its ability to depot fulvestrant and inhibit the growth of breast cancer cell lines. Results: Adipose tissue harvested from patients did not promote breast cancer cell growth in vitro or in an in vivo mouse model. Adipose tissue was successfully loaded with fulvestrant and released at levels sufficient to inhibit estrogen receptor signaling and growth of breast cancer cells. Conclusions: This work supports the hypothesis that adipose tissue used for autologous fat grafting can serve as a novel method for local drug delivery. As this technique is used to reconstruct a variety of postsurgical defects following cancer resection, this approach for local drug delivery may be an effective alternative in therapeutic settings beyond breast cancer.
Tissue Engineering Part A, 2011
Adipose-derived stem cells (ASCs) have been proposed to stabilize autologous fat grafts for regenerative therapy, but their safety is unknown in the setting of reconstructive surgery after mastectomy. Both bone marrow mesenchymal stem cells (MSCs) and ASC have been shown to enhance tumorigenesis of established breast cancer cell lines, but primary patient material has not been tested. Here, we ask whether ASC promote the in vitro growth and in vivo tumorigenesis of metastatic breast cancer clinical isolates. Metastatic pleural effusion (MPE) cells were used for coculture experiments. ASC enhanced the proliferation of MPE cells in vitro (5.1-fold). For xenograft experiments (100 sorted cells/injection site), nonhematopoietic MPE cells were sorted into resting and active populations: CD90þ resting (low scatter, 2.1% !2N DNA), CD90þ active (high scatter, 10.6% !2N DNA), and CD90À. Resting CD90þ MPE cells were tumorigenic in 4/40 sites but growth was not augmented by ASC. Active CD90þ MPE cells were tumorigenic (17/40 sites) only when coinjected with ASC (p ¼ 0.0005, w 2 test). The multilineage potentiality and MSC-like immunophenotype of ASC were confirmed by flow cytometry, differentiation cultures, and immunostaining. The secretome profile of ASC resembled that reported for MSC, but included adipose-associated adipsin and the hormone leptin, shown to promote breast cancer growth. Our data indicate that ASC enhance the growth of active, but not resting tumor cells. Thus, reconstructive therapy utilizing ASC-augmented whole fat should be postponed until there is no evidence of active disease.
Journal of Investigative Surgery, 2020
Background: Autologous fat grafting (AFG) is a recognized surgical procedure to correct deformities following breast conservation surgery (BCS) for breast cancer. However, there are concerns about the oncological safety of this technique. In this study we have reviewed the current literature to assess whether AFG adversely influences the oncological outcome after BCS for breast cancer. Methods: We have searched the medical literature using the Embase and PubMed search engines from conception until May 2019 to identify all relevant studies of patients who underwent AFG after BCS. Meta-analysis and meta-regression methodologies were used to calculate the overall relative risk (RR) of loco-regional recurrence (LRR) rates for case-control and case series studies (with historical controls) respectively. Results: We have identified 26 eligible studies with a total of 1640 patients who had undergone fat transfer after lumpectomy for breast cancer. The meta-analysis of 11 studies revealed an overall RR for LRR of 0.82 [95% confidence interval (CI):0.14-1.66]. The meta-regression of case series revealed an overall incidence of LRR of 1.85% compared with 2.53% for historical controls. Conclusions: Our study lends further support to the notion that fat transfer after lumpectomy for breast cancer does not seem to increase the risk of LRR. However further prospective research is required in order to confirm this.
Journal of Biomedical and Allied Research, 2023
Autologous fat grafting is an appealing method for breast reconstruction following mastectomy for breast cancer. Surgeons often perform this technique to optimize the aesthetic results of the more popular implant-based or autologous breast reconstruction by correcting residual defects and contour lines. Autologous fat grafting is less invasive, less costly, and easier than the reconstructive procedures mentioned. These advantages pose the possibility of using this method as a stand-alone procedure for post-mastectomy breast reconstruction. However, the literature is inconsistent when describing harvesting and processing methods and reporting patient outcomes. Graft retention rates are also variable. The use of adipose-derived stem cells can address the issue of unpredictable graft retention due to their angiogenic and adipogenic action. The novelty of using stem cells with autologous fat grafting also raises concerns, especially regarding its oncologic safety. This review aims to present a critical perspective of the literature on autologous fat grafting as a stand-alone procedure for post-mastectomy breast reconstruction and highlight areas for further research that can improve its outcome. Moreover, it discusses the potential use of adipose-derived stem cells in conjunction with autologous fat grafting to improve graft retention and the considerations surrounding the safety of this procedure.
Fat grafting in autologous breast reconstruction: applications, outcomes, safety, and complications
Plastic and Aesthetic Research, 2023
Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures. Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability; it can be used independently to replace more invasive flap procedures or implants, or as an adjunct for smaller volume supplementation. The breadth of applications in the breast necessitates diversity in technique and approach, and while there is no universally agreed-upon protocol, basic principles have guided the evolution of some commonly adopted tenets. Broadly, fat grafting outcomes are highly favorable but dependent on patient and procedure factors, requiring learned patient selection and expertise in recipient site assessment. Common complications from fat grafting, such as fat necrosis and the development of nodules, are particularly troublesome for post-oncologic patients, requiring considerable pre-surgical consultation for patient education and managing expectations. In addition to volume and contour augmentation, fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or post-mastectomy pain syndrome, improved skin quality and reduced fibrosis following radiation, and possible anti-tumorigenic effects. New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma. Preclinically, research towards safe and effective regenerative medicine approaches is actively underway, with the ultimate goal of achieving predictable and increased graft retention, reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.
Autologous Fat Grafting Does Not Increase Risk of Oncologic Recurrence in the Reconstructed Breast
Annals of Plastic Surgery, 2020
Introduction: Autologous fat grafting (AFG) is a popular and effective method of breast reconstruction following mastectomy; however, the oncological safety of AFG remains in question. The purpose of this study is to determine if AFG increases the risk of cancer recurrence in the reconstructed breast. Methods: A matched, case-control study was conducted from 2000 to 2017 at the senior author's institution. Inclusion was limited to female patients who underwent mastectomy and breast reconstruction with or without AFG. Data were further subdivided at the breast level. Chi-square analyses were used to test the association between AFG status and oncologic recurrence. A Cox proportional-hazards model was constructed to assess for possible differences in time to oncologic recurrence. The probability of recurrence was determined by Kaplan-Meier analyses and confirmed with log-rank testing. Results: Overall, 428 breasts met study criteria. Of those, 116 breasts (27.1%) received AFG while 312 (72.9%) did not. No differences in the rates of oncologic recurrence were found between the groups (8.2% versus 9.0%; p < 1.000). Unadjusted (HR:1.03, CI: 0.41-2.60; p < 0.957) and adjusted hazard models showed no statistically significant increase in time to oncologic