Establishing oncological safety of autologous fat transfer for total breast reconstruction: Results from the multicentre BREAST-I and BREAST-II trials

Wessel B W van der Venne¹, Roos Michiels², Sander M J van Kuijk³, Vivianne C G Tjan-Heijnen⁴; BREAST trial investigators; BREAST-II trial investigators; René R W J van der Hulst⁵, Esther M Heuts⁶, Andrzej Piatkowski⁷

Collaborators, Affiliations

Collaborators

BREAST trial investigators:
Andrzej Piatkowski, Juliette E Hommes, Sander Sj Schop, Todor K Krastev, Sander Mj van Kuijk, René Rwj van der Hulst, Danielle Derks, Mikko Larsen, Hinne Rakhorst, Ute Schmidbauer, Jan Maerten Smit, Liang T Tan, Kim M E Wehrens, Thijs de Wit
BREAST-II trial investigators:
Andrzej A Piatkowski de Grzymala, Juliette E Hommes, Sander S J Schop, Jamilla L M Wederfoort, Maud E P Rijkx, Wessel B W van der Venne, Xavier H A Keuter, Sander M J van Kuijk, Thijs de Wit, Patrick I Fernandinus, Rose J T R Rhemrev, Marjolein M de Lange, Jan-Maerten Smit, Naomi van Hout, Caroline Driessen, Hinne Rakhorst, Ute Schmidbauer, An E K Deliaert, Henriëtte C Kroese, Corinne Schouten, Chantal M Mouës, Pauline M Huizinga

Affiliations

¹ Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, P.O. box 5800, Maastricht, 6202 AZ, the Netherlands; NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
² Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
³ Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, 6229 HX, the Netherlands.
⁴ GROW School for Oncology and Reproduction, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands; Department of Medical Oncology, Maastricht University Medical Center (MUMC), Maastricht, 6229, the Netherlands.
⁵ Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, P.O. box 5800, Maastricht, 6202 AZ, the Netherlands; NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
⁶ Department of General Surgery, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, 6202 AZ, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands; School of Health Professions Education (SHE), Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
⁷ Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, P.O. box 5800, Maastricht, 6202 AZ, the Netherlands; NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands. Electronic address: andrzej.piatkowskidegrzymala@mumc.nl.

PMID: 41643626
DOI: 10.1016/j.ejso.2026.111417

Free article

Establishing oncological safety of autologous fat transfer for total breast reconstruction: Results from the multicentre BREAST-I and BREAST-II trials

Wessel B W van der Venne et al. Eur J Surg Oncol. 2026.

Free article

. 2026 Jan 29;52(3):111417.

doi: 10.1016/j.ejso.2026.111417. Online ahead of print.

Authors

Collaborators

BREAST trial investigators:
Andrzej Piatkowski, Juliette E Hommes, Sander Sj Schop, Todor K Krastev, Sander Mj van Kuijk, René Rwj van der Hulst, Danielle Derks, Mikko Larsen, Hinne Rakhorst, Ute Schmidbauer, Jan Maerten Smit, Liang T Tan, Kim M E Wehrens, Thijs de Wit
BREAST-II trial investigators:
Andrzej A Piatkowski de Grzymala, Juliette E Hommes, Sander S J Schop, Jamilla L M Wederfoort, Maud E P Rijkx, Wessel B W van der Venne, Xavier H A Keuter, Sander M J van Kuijk, Thijs de Wit, Patrick I Fernandinus, Rose J T R Rhemrev, Marjolein M de Lange, Jan-Maerten Smit, Naomi van Hout, Caroline Driessen, Hinne Rakhorst, Ute Schmidbauer, An E K Deliaert, Henriëtte C Kroese, Corinne Schouten, Chantal M Mouës, Pauline M Huizinga

Affiliations

¹ Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, P.O. box 5800, Maastricht, 6202 AZ, the Netherlands; NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
² Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
³ Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, 6229 HX, the Netherlands.
⁴ GROW School for Oncology and Reproduction, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands; Department of Medical Oncology, Maastricht University Medical Center (MUMC), Maastricht, 6229, the Netherlands.
⁵ Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, P.O. box 5800, Maastricht, 6202 AZ, the Netherlands; NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
⁶ Department of General Surgery, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, 6202 AZ, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands; School of Health Professions Education (SHE), Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
⁷ Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, P.O. box 5800, Maastricht, 6202 AZ, the Netherlands; NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands. Electronic address: andrzej.piatkowskidegrzymala@mumc.nl.

PMID: 41643626
DOI: 10.1016/j.ejso.2026.111417

Abstract

Background: Autologous fat transfer (AFT) has gained popularity as a minimally invasive alternative for autologous breast reconstruction post-mastectomy. It offers aesthetic advantages and improvements in quality-of-life, though concerns persist regarding its oncological safety due to the presence of adipose-derived stem cells (ADSCs).

Methods: This pooled follow-up analysis combined data from the multicentre randomised controlled BREAST-I trial and the nonrandomised clinical BREAST-II trial, including women who underwent total breast reconstruction with AFT between 2015 and 2025. The AFT-cohort was compared with a nationwide control group of breast cancer patients derived from the Netherlands Cancer Registry (IKNL), matched by inverse probability weighting. The primary outcome was overall survival (OS). Local and regional recurrences and distant metastases were not included in statistical analyses due to known underreporting in the national registry, but were descriptively assessed within the study cohort.

Results: A total of 242 AFT-patients and 19936 controls were included. The mean follow-up time was 8.0 years for AFT and 6.9 years for controls. Ten-year crude OS was 97.6 % (95 % CI 95.5-99.7 %) for AFT and 75.7 % (95 % CI 74.7-76.8 %) for controls. After adjustment for confounders and immortal time bias, AFT was not associated with increased mortality (HR 0.34; 95 % CI 0.14-0.88; p = 0.025). Residual confounding and differences in follow-up intensity between cohorts constitute key study limitations.

Conclusions: In this pooled multicentre cohort with long-term follow-up, AFT for total breast reconstruction after mastectomy did not negatively affect mortality compared with national registry controls. These results support the oncological safety of AFT as a reconstructive technique. Future research should include larger cohorts and assess disease-free survival.

Keywords: Autologous fat transfer; Breast cancer; Breast cancer recurrence; Distant metastasis; Fat grafting; Oncological safety; Overall survival; Post-mastectomy breast reconstruction.

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Conflict of interest statement

Conflict of interest disclosures Prof. Dr. Piatkowski reported receiving financial support from ZonMw through the Conditional Reimbursement Admissions Grant Program during the course of this study. No other conflicts of interest were reported by any of the authors.

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Establishing oncological safety of autologous fat transfer for total breast reconstruction: Results from the multicentre BREAST-I and BREAST-II trials

Collaborators

Affiliations

Establishing oncological safety of autologous fat transfer for total breast reconstruction: Results from the multicentre BREAST-I and BREAST-II trials

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

LinkOut - more resources

Full Text Sources