1. LIPOFILLING AFTER BREASTLIPOFILLING AFTER BREAST
CANCERCANCER
JY Petit
IEO Milan

2. Fat transferFat transfer
• Plastic surgery revolutionPlastic surgery revolution
• Multiple indicationsMultiple indications
(Aesthetic surgery)(Aesthetic surgery)
• Oncologic safety ?Oncologic safety ?

4. Conservative treatment
improvement
Fat injection -results

5. Implant reconstruction
50 gm – Local anesthesia

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

7. Pressure Sore-Day 145

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 »

11.  109 references
 8 clinical series

12. Few cancer
reconstructions
No oncologic dataShort Follow up
No data on
oncologic
safety
No oncological FU

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

16. Adipocytes produce
adipokines
(leptines, growth factors etc. )
Stimulates angiogenesis and
cancer cell growth
Endocrine, Paracrine, Autocrine action

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)

19. Complications rates 3,6%

20. Mammografic modifications post
lipofilling: 4 cases
benign aspect no biopsy
Local recurrence: 1 case
(find out 8 days after LF)

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)

24. Matching criteriae

25. Overall incidence – comparable excepts in “In Situ” cancer

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
« ieo-breastcancer.com »