Lipofilling in Breast Oncological Surgery: A Safe Opportunity or Risk for Cancer Recurrence?

Abstract

Lipofilling (LF) is a largely employed technique in reconstructive and esthetic breast surgery. Over the years, it has demonstrated to be extremely useful for treatment of soft tissue defects after demolitive or conservative breast cancer surgery and different procedures have been developed to improve the survival of transplanted fat graft. The regenerative potential of LF is attributed to the multipotent stem cells found in large quantity in adipose tissue. However, a growing body of pre-clinical evidence shows that adipocytes and adipose-derived stromal cells may have pro-tumorigenic potential. Despite no clear indication from clinical studies has demonstrated an increased risk of cancer recurrence upon LF, these observations challenge the oncologic safety of the procedure. This review aims to provide an updated overview of both the clinical and the pre-clinical indications to the suitability and safety of LF in breast oncological surgery. Cellular and molecular players in the crosstalk between adipose tissue and cancer are described, and heterogeneous contradictory results are discussed, highlighting that important issues still remain to be solved to get a clear understanding of LF safety in breast cancer patients.

Keywords: adipose tissue; adipose-derived stromal cells; breast cancer; breast cancer recurrence; breast reconstruction; lipofilling; oncological safety; pre-clinical studies.

Figure 1

Lipofilling for breast reconstruction. (A) The liposuction syringe is centrifuged to separate purified fat from debris. Centrifuged lipoaspirate is separated into three phases: the oily fraction coming from disrupted adipocytes, watery fraction, which consists of blood, lidocaine, and saline injected before the liposuction, and the purified fat between the oily and watery fractions. Stromal vascular fraction (SVF) can be obtained from the whole adipose tissue by further digestion and centrifugation steps. (B) Harvested fat is injected into the mammary tissue. Several factors, such as growth factors, adipokines, and extracellular vesicles (EVs) are secreted by adipose-derived stromal cells (ASCs), adipocytes, and other cells of the adipose tissue, but if and how they could stimulate BC survival, progression, and metastasis is still debated.