Fat Grafting’s New Controversy: Does It Increase the Risk of Recurrence?

For women weighing up the pros and cons of the various breast reconstruction techniques, fat grafting is a tempting choice due to the promise of a non surgical technique and results of soft breasts using your own tissue. The added bonus is the tissue is sourced from fatty areas of the body. But the jury is still out as to the longer term safety of this technique for post breast cancer women. 

​This article by Kara Skarda for Air Axpanders blog

Almost as a side note, in a larger and more expected conversation about obesity increasing the risk of breast cancer, fat grafting as a breast reconstruction option took a significant hit this past month.

It’s No Longer About Radiographic DetectionFat grafting as a breast reconstruction technique has really had quite a dramatic history, The first known fat-grafting breast reconstruction occurred in 1895, when Vincenz Czerny transferred a lipoma from the buttocks of a patient to her breasts. However, the medical community’s acceptance of the procedure did not grow in proportion to time.

​In 1987, the American Society of Plastic and Reconstructive Surgeons published a very strongly worded position paper against the use of fat grafting for breast reconstruction due to the diagnostic challenge of distinguishing between fat necrosis and cancerous tumors. Fat grafting, as a breast reconstructive option, nearly disappeared.

Thankfully, radiology has come a long ways in the last couple decades, and in an exciting moment in the world of breast reconstruction, a March 2007 paper in Plastic and Reconstructive Surgery  (the journal of the American Society of Plastic Surgeons) boldly countered the original ASPRS position with their own research that fat grafting presented no greater diagnostic challenge than any other reconstruction method. Their harsh concluding words rang through the medical community and helped reintroduce fat grafting as a legitimate option. Finally, in 2008, the American Society of Plastic Surgeons reversed its stance.
Since then, fat grafting has grown as a legitimate option facing women, causing today’s news to send shivers up and down quite a few spines.

Myofibroblasts and a Stiff Intracellular MatrixThe paper, which was published in the Science Translational Medicine, found that obesity at all ages has a strong correlation to breast cancer risk. Though this finding alone is significant, it would not have been particularly novel. However, more specifically, researchers studied the differences between fatty and leaner tissue.
What they found is that obesity changes the extracellular matrix (the space between cells), making the tissue more rigid and denser. Obese tissue has an increased number of myofibroblasts (cells ordinarily important to repairing wounds), which release a denser protein structure. It is unclear what role the adipose stem cells (ASC) play in this process.

This stiff extracellular matrix then provides the ideal environment for tumor growth, though the exact mechanism is not understood. When the researchers cultured human breast cancer cells and premalignant breast cells, both grew faster on the matrix from obese mice than from thinner mice. Of course, mice are not women, but as obese women also show the same denser breast tissue, along with a higher rate of breast cancer, than thinner women, scientists believe they may be beginning to understand some of the causes of increased breast cancer among obese women.

The Fat Grafting ConnectionHowever, it is not just obese women who should be concerned. The scientists called the research “a cautionary tale” for fat grafting for breast reconstruction. In an article in The Verge, one of the researchers, Claudia Fishbach, suggested that the use of adipose tissue for breast reconstruction could potentially “activate residual breast cancer cells after mastectomy.” If introducing fatty tissue back to the chest would cause the same stiff extracellular matrix to form, there is the potential for the same tumorigenesis process to restart.

Unfortunately, this falls in line with other research questioning fat grafting’s connection to breast cancer recurrence. In January of this year, researchers in the British Journal of Cancer called for more research on the link of fat grafting to breast cancer recurrence:

        "In the BC [breast cancer] field, we believe that the hype for the exciting results in terms           of WAT [white adipose tissue] progenitor cell engraftment and tissue augmentation                   should be tempered when considering the recent and abundant preclinical studies,                     indicating that WAT [white adipose tissue] progenitors may promote BC [breast cancer]           growth and metastasis."

Likewise, in 2013 in the journal Stem Cell Discovery, researchers warned clinicians, “Although the literature offers contrasting opinions concerning the effects of ASCs [adipose stem cells] on cancer growth according to the tumor type, at the present time ASC [adipose stem cell] implementation for regenerative medicine therapies should be carefully considered in patients previously treated for breast cancer.”
At best, right now clinicians (and patients) have significant reasons to hesitate and consider all other options before opting for fat grafting as a reconstruction method. Many women may choose instead a combination of a skin-sparing mastectomy and breast implants rather than run the risk of bringing potentially cancer-promoting tissue back to their breasts.


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