Breast-conserving surgery and immediate autologous fat transfer with or without neoadjuvant treatment: indications, technique, cosmetic and oncologic outcomes

Background: The objective of this study was to analyze the usefulness of immediate fat transfer to prevent sequelae of both primary breast-conserving surgery and in a subgroup of patients with an indication for conservative surgery after neoadjuvant treatment. Methods: Ninety-one patients who underwent breast-conserving surgery and breast reconstruction with autologous fat transfer in the same surgery were included. Sixty-one underwent primary surgery without neoadjuvant treatment (BCT-AFT) and 30 patients underwent surgery after neoadjuvant treatment (BCTAFT-NEO). Patients included in the BCT-AFT group had stage I (15%) and stage II (85%) disease, and their immunohistochemical profile was Luminal A 65.5% and Luminal B 34.5%. In the BCT-AFT-NEO group, 76.5% were stage III and the rest in stage II 24.5%, their immunohistochemical profile was Luminal A in 6.5%, Luminal B: 56.5%, triple negative: 26.5% and Her2+ 10%. All patients received adjuvant radiotherapy and systemic treatment in accordance with the Institution's guidelines. The fat was transferred to the breast tissue, the retromammary region and the subcutaneous tissue after glandular modeling. The mean volume of fat transferred was 85 g (range, 45-225 g). Results: The cosmetic evaluation showed very good or good results in 89% of the patients. Followup mammography at 6 and 18 months showed 2 BIRADS IV images that were biopsied and were cytosteatonecrosis. The overall rate of surgical complications for the entire series was 5.49%. The mean follow-up was 25.21 months in the BCT-AFT group and 20.9 months in the BCT-AFT-NEO group. None of the patients in either group developed locoregional recurrences during the study period. Two patients developed distant metastases. Conclusions: This correctly indicated technique is promising in patients with invasive tumors with or without prior neoadjuvant treatment with an indication for conservative treatment. The high rate of good aesthetic results obtained was maintained in all patients beyond 18 months of radiotherapy. No local recurrences were recorded during the follow-up period in any of the subgroups analyzed. These variables need to be validated in longer -term follow-up and require multidisciplinary prospective trials to assess the role of immediate lipofilling in routine breast-conserving surgery in patients with breast cancer.