The Role of Autologous Fat Grafting for Breast Reconstruction

Author: Benjamin Howes

Howes, Benjamin, 2018 The Role of Autologous Fat Grafting for Breast Reconstruction, Flinders University, School of Medicine

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The past decade has seen increasing interest in the development and use of autologous fat grafting for breast reconstruction. This thesis presents a review of the literature on the broad application and science of fat grafting and a review of the clinical literature on the cohort of women who have undergone mastectomy for breast cancer and subsequent fat grafting for breast reconstruction. The areas explored in the systematic review include efficacy, fat grafting and breast cancer oncogenesis, complications and outcomes.

Whether there is a need for the option of autologous fat grafting in women who have undergone breast conserving surgery was investigated (Chapter 3). Breast conserving surgery is the current mainstay of treatment for early breast cancer and outcomes were studied using the BREAST-Q patient reported outcome measure. It was identified that up to 15% of women with breast conserving surgery would consider reconstructive surgery and an appropriate procedure for minor defect correction is autologous fat grafting. Interestingly when controls, women with breast conservation, women with mastectomy alone and women with mastectomy and reconstruction were compared, women with mastectomy and reconstruction reported outcomes at least as good as those with breast conserving surgery.

A study of the efficacy of the BRAVA® external expander device and autologous fat grafting for breast reconstruction in women who have undergone breast conserving surgery and total mastectomy is described in Chapter 5. The idea for this project came from a conference presentation on the improved efficacy and enhanced fat graft ‘take’ when the BRAVA® external expander is used in combination with fat grafting. This study used previously validated quantitative measures of outcome including, magnetic resonance imaging, 3D laser scanning and the BREAST-Q to quantify the proportion of fat graft retained in reconstructive cases and measure outcome as perceived by the patients. Rates of fat graft retention were found to be poorer than those described by the original group using the device with the mean proportion of fat retained being 48% at 12 months post-injection.

Since the start of the modern era of autologous fat grafting (in the early 2000s) there has been ongoing debate in the plastic surgery and breast cancer community regarding laboratory and clinical evidence for risk of oncogenesis and the interaction of adipose derived stem cells in the breast cancer microenvironment. This debate was the stimulus for the laboratory study (Chapter 7) investigating the morphology and behaviour of both benign and malignant breast cells in the presence of autologous fat from various sources. Although the laboratory studies were preliminary in nature the growth rates of benign breast cells in 2D culture were found to be higher in media containing autologous fat compared to those in baseline media and there were some differences in cell morphology between those in control medium and those in media containing autologous fat.

Keywords: Autologous, fat grafting, breast reconstruction

Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: School of Medicine
Supervisor: Nicola Dean