Evaluation of Immediate Reconstruction with Lipofilling Following Breast Conserving Surgery for Early Breast Cancer

Background: Early-stage breast cancer is defined as disease confined to the breast with or without regional lymph node involvement, and the absence of distant metastatic disease. In Breast-conserving surgery (BCS), only the tumor (lumpectomy) or maximally the quadrant where the tumor located is removed.

Aim of the Work: to evaluate the cosmetic outcome and oncologic safety of immediate lipofilling in cases of early breast cancer eligible for breast conserving surgery.

Methods: This prospective study was conducted on 40 patients presented with early breast cancer at the Surgical Oncology Unit, General Surgery Department, Tanta University Hospitals. All patients underwent breast conserving surgery by wide local excision of the tumor with free resection margins. Immediate lipofilling was performed by variable volumes of processed fat according to the volumes of the resultant resection defects. The patients were followed up clinically after 15 days, 3 months postoperatively to detect the early and late complications. After 6 months, mammography with complementary ultrasonography were performed to evaluate the graft and detect any complication. FNAC was done to reach the precise diagnosis of any radiological abnormality and exclude any local recurrence. The aesthetic outcome was evaluated objectively and subjectively after 6 months by a scoring system of five items: Asymmetry,breast shape, nipple, skin, wound (ABNSW Score)

Results: The average volume of resection defects was 24.4 cc. The average volume of the grafted fat was 49.7 cc. Fifteen days postoperatively, 28 cases had normal skin, four cases had small hematoma, four cases developed mild cellulitis, and four cases had superficial wound infection. After three months, 38 cases had normal overlying skin and two case still had mild wound infection that improved by treatment. After six months, mammography with complementary ultrasonography revealed architectural distortion in 18 cases, calcified hematoma in 14 cases, oil cyst in 4 cases, and chronic abscess in 4 cases. By FNAC, sixteen cases (40%) had giant cell reaction,ten cases (25%) had chronic inflammation, fat necrosis was diagnosed in 8 cases (20%), normal breast tissue was detected in 4 cases (10%). No local recurrence was recorded in any case. Fortunately, 38 cases had good to excellent results by the scoring system ABNSW with the mean total score was 13.2.

Conclusion: Breast conserving surgery with immediate lipofilling offers superior cosmetic outcomes than traditional reconstructive techniques.