1) Fat transfer, also known as lipofilling, is increasingly used for breast reconstruction after cancer, but its oncological safety is unclear.
2) A recent study at IEO compared 321 breast cancer patients who underwent lipofilling to a matched control group who did not, and found no evidence of increased local recurrence rates except possibly for in situ cancers.
3) More long-term follow up data is still needed from prospective studies, especially for in situ breast cancer cases, to definitively assess the oncological safety of lipofilling techniques.
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
Pr Olivier Glehen (Lyon - France) presents HIPEC in treatment for colorectal and gastric carcinomatosis. La CHIP dans le traitement des carcinoses péritonéales d'origine colorectale et gastrique.
6. Immediate Pre-op Intraop after debridement
25 Days Post Op 41 Days Post Op
Intra-op after Cell Tx
14 Days Post Op
90 y old women 40 years after abdominal radiation therapy
and non healing sacral pressure sore
90% cells to circular area around sore
10% cells to sore itself
G. Rigotti
8. Cell Enhanced Autologous Fat Graft
Not FDA approved
Cell
isolation
Washing
Combine to
Cell Enhanced
Fat Graft
50%
50%
Michael Sheflan 09
9. when transferring thewhen transferring the
specimenspecimen inin
Breast cancerBreast cancer
patientspatients
?
Are we sure of Cancer safety
2010
10. «… no study suggesting an increasing
risk of recurrence. But no study with
high level of evidence »
« No solid results in the literature:
the task force cannot give any
spécific recommendation »
13. Oncologic eventsOncologic events
were comparablewere comparable
““Before” and “After”Before” and “After”
grafting periodgrafting period
Relevance ?Relevance ?
Comparable ?Comparable ?
Oncologic event ?Oncologic event ?
?!
14. De Lorenzi F, Lohsiriwat V, Petit JY.De Lorenzi F, Lohsiriwat V, Petit JY.
In Response To: Rigotti G, Marchi A, Stringhini P et al.In Response To: Rigotti G, Marchi A, Stringhini P et al. "Determining the Oncological Risk of"Determining the Oncological Risk of
Autologous Lipoaspirate Grafting for Post-Mastectomy Breast Reconstruction".Autologous Lipoaspirate Grafting for Post-Mastectomy Breast Reconstruction".
Aesthetic Plast Surg. 2011 Feb;35(1):132-3.Aesthetic Plast Surg. 2011 Feb;35(1):132-3.
I II
Period I and II are “NOT” comparable
U.Veronesi NEJM 2002 October
B. Fisher NEJM 2002 October
Lipofilling
15. selection of fundamental research publications
41 articles
Published between 1992 and 2009
Search > 100 papers
Breast. 2011 Feb 4.
Autologous fat transplantation in patients
with breast cancer: "silencing" or "fueling"
cancer recurrence?
Lohsiriwat V, Curigliano G, Rietjens M, Goldhirsch A, Petit JY.
IEO recent clinical studyIEO recent clinical study
17. IEO recent clinical studyIEO recent clinical study
2010 in JPRAS
2011 in PRS (August 2011)
18. First study
(Oct 2005- July 2008)
Lipofilling of the breast 194 cases
using Coleman technique
114 after mastectomy
77 after conservative treatment
(26 patients underwent several injections)
21. No definitive conclusion
need of a prospective clinical
study
with a control group to
demonstrate statistically the
safety of the lipofilling
22. •1997-20081997-2008
•321 breast cancer patients who321 breast cancer patients who
subsequently underwent lipofillingsubsequently underwent lipofilling
•2:1 matched-patients with similar2:1 matched-patients with similar
characteristics who did notcharacteristics who did not
undergo a lipofilling.undergo a lipofilling.
Annals of Oncology (accepted)
26. CONCLUSION
1. No evidence of increasing risk of
LRR after Lipofilling (In situ group?)
2- Final results after longer FU of
prospective control studies (in
situ cases)
3- Special focus on the techniques of
stem cells selection (Cytori) and
growth factor addition (Japan)
27. International workshop on Cancer
and Breast Reconstructive
Live surgery & interactive Video sessions
20-22June 2011
Information and contact on IEO website
Full HD 3D transmission
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