Cancer Recurrence After Fat Transfer (CRAFT)
Ida J. Wagner, MD1, Terry M. Myckatyn, MD1, Babak J. Mehrara, MD2, Melissa A. Crosby, MD3, Julie E. Park, MD4, Dominic T. Moore, PhD5, Bahjat F. Qaqish, PhD5, Evan L. Busch, BA, MPH5, Amanda K. Silva, MD4, Surinder Kaur, PhD6, David W. Ollila, MD5, Clara N. Lee, MD5.
1Washington University St. Louis, St. Louis, MO, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3MD Anderson Cancer Center, Houston, TX, USA, 4University of Chicago, Chicago, IL, USA, 5University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 6Plastic Surgery Foundation, Chicago, IL, USA.
Grafted adipose cells injected into a former breast cancer tumor bed have the potential risk of promoting growth of residual tumor cells, resulting in a cancer recurrence. We hypothesize that fat grafting in breast cancer patients increases the risk of recurrence.
The association of injection of autologous fat with breast cancer recurrence, excluding distant metastasis or a contralateral primary tumor, was evaluated. A multi-center, case-cohort study identified 3271 patients across 4 centers via institutional tumor registries. Eligibility criteria included patients who underwent mastectomy with immediate breast reconstruction from 2006-2011, age above 21, female sex, and a diagnosis of invasive ductal carcinoma stage I, II or III. All recurrences were compared with a 35% random sample (1082 patients) of the total patient population. Cox regression was used to evaluate the possible association of selected covariates of interest on time to recurrence in both univariable and multivariable models.
76 of 1082 of patients underwent fat grafting as part of breast reconstruction after mastectomy. The recurrence hazard ratio estimate for fat grafting is 0.98 (95%, CI 0.55-1.77), adjusted for age, BMI, stage, Her2neu, estrogen (ER) and progesterone receptor (PR) status. Cancer TNM stage was associated with recurrence (p<0.0001), along with age (p=0.03), Her2Neu (p=0.006) and PR (p=0.003), while BMI, ER, and fat grafting were not (p=0.26, p=0.88 and p=0.96 respectively).
In this sample, fat grafting was not significantly associated with an increased risk of breast cancer recurrence.
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