The French Society of Plastic Surgery(SoFCPRE), to which we belong, has issued new recommendations concerning breast augmentation by fat injection into the breasts for aesthetic purposes or breast reconstruction.
One of the main limitations of fat-injected breast augmentation is that the scars caused by the injected fat may give rise to radiological images that would interfere with breast cancer surveillance. The other uncertainty is the possible risk of an increase in breast cancer. To date, there have been no scientific studies suggesting a significant increase in the risk of breast cancer in women with no previous history of breast fat injections. On the other hand, it's true that we don't have any long-term studies proving that there is no increase in this risk, particularly given that breast cancer affects one in 10 women in the general population.
For aesthetic purposes
The technique is therefore proposed by the French Society of Plastic Surgery for women with no risk of breast cancer: under 35 years of age, with no personal or family history of breast cancer, and after a negative breast X-ray (mammogram and ultrasound).
Personally, we feel that the 35-year age limit is a little arbitrary, given that the maximum risk of breast cancer occurs between the ages of 50 and 65. On the other hand, it seems clear to me that women with a first-degree family history of breast cancer should be excluded. The essential point is the quality of the radiological assessment and the need for long-term follow-up in a specialized center. For our part, before such an operation, we request a mammogram, ultrasound and magnetic resonance imaging, carried out by a specialist radiologist. The same assessment is repeated 3 months after the operation, by the same radiologist. Thereafter, we do not recommend repeating these examinations before breast cancer screening at age 50.
Breast reconstruction
The company validates this technique after total breast removal. In fact, the risk of local recurrence is judged to be extremely low.
The situation is much more complex when it comes to treating the aesthetic after-effects of conservative treatments. These are women whose breast cancer has been treated by lumpectomy (partial removal of the breast around the tumor) followed by radiotherapy, and who present aesthetic after-effects in the form of notches. In these cases, the risk of local recurrence (relapse of the cancer in the breast) is high (around 5% chance of recurrence at 5 years in women over 50). Fat injection can address this problem, but it directly opposes the desired effect of radiation, which aims to "atrophy" tissue so that the cancer cannot return. What's more, some studies have found a higher rate of local recurrence in injected women. In these cases, the SoFCPRE recommends a minimum delay of 3 years between the cancer and the fat injection. Once again, we have some reservations, and will adapt this recommendation to the patient's age at the onset of her breast cancer. Women under 40 have a much higher rate of local recurrence. We will maintain a minimum delay of 5 years between the ages of 40 and 50, and 10 years before the age of 40.
In addition, SoFCPRE members are committed to anonymously reporting all cases of fat injection into the breasts via the Internet, in order to establish a national database and be able to publish the long-term results of this technique.
We believe that these recommendations, even if they call for some criticism, have the merit of highlighting the fact that plastic surgeons evaluate their practices and prioritize safety for their patients.
We have chosen to carry out fat injections for aesthetic purposes, because we believe it is a reliable technique that gives a natural result without the disadvantages of a silicone implant. However, we inform our patients of the limitations and uncertainties associated with this procedure. In addition, we have set up care networks with expert radiologists to enable us to follow our patients over the long term.
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