Marie Wickman

Background Radiation‐induced fibrosis, an adverse effect of breast cancer treatment, is associated with functional and cosmetic impairment as well as surgical complications. Clinical reports suggest improvement following autologous fat transplantation, but the mechanisms underlying this effect are unknown. A global gene expression analysis was undertaken to identify genetic pathways dysregulated by radiation and evaluate the impact of autologous fat transplantation on gene expression. Methods Adipose tissue biopsies were taken synchronously from irradiated and contralateral non‐irradiated breasts, before and 1 year after autologous fat transplantation. Whole‐genome gene expression analyses were performed, and Hallmark gene set analysis used to explore the effect of radiotherapy and autologous fat transplantation on gene expression. Results Forty microarrays were analysed, using bilateral biopsies taken from ten patients before and after autologous fat transplantation. Forty‐five pathways were identified among the 3000 most dysregulated transcripts after radiotherapy in irradiated compared with non‐irradiated breast (P ≤ 0·023; false discovery rate (FDR) no higher than 0·026). After autologous fat transplantation, 575 of the 3000 genes were again altered. Thirteen pathways (P ≤ 0·013; FDR 0·050 or less) were identified; the top two canonical pathways were interferon‐γ response and hypoxia. Correlative immunohistochemistry showed increased macrophage recruitment in irradiated tissues. Conclusion The present findings contribute to understanding of how autologous fat transplantation can ameliorate radiation‐induced fibrosis. This further supports the use of autologous fat transplantation in the treatment of radiation‐induced fibrosis. Surgical relevance Clinical studies have indicated that autologous fat transplantation (AFT) stimulates regression of chronic inflammation and fibrosis caused by radiotherapy in skin and subcutaneous fat. However, there is a paucity of biological evidence and the underlying processes are poorly understood. Human data are scarce, whereas experimental studies have focused mainly either on the effect of irradiation or AFT alone. The present results indicate that radiotherapy causes dysregulated gene expression in fibrosis‐related pathways in adipose tissues in humans. They also show that AFT can cause a reversal of this, with several dysregulated genes returning to nearly normal expression levels. The study provides biological evidence for the impact of AFT on radiation‐induced dysregulated gene expression in humans. It supports the use of AFT in the treatment of radiation‐induced fibrosis, associated with severe morbidity and surgical challenges.

Background: Autologous fat transplantation (AFT) is being increasingly used to improve the results after breast-conserving surgery and breast reconstruction. However, studies on patient-reported outcomes (PROs) and health-related quality of life (HRQoL) after AFT are scarce. The aim of this prospective longitudinal case-series study was to assess PRO in women who had undergone AFT after surgery for breast cancer or risk-reducing mastectomy. Methods: Fifty women, who had undergone breast-conserving surgery or breast reconstruction, needing corrective surgery, were consecutively included between 2008 and 2013. A 20-item study-specific questionnaire (SSQ) and the Short Form Health Survey (SF-36) were used pre-operatively and 6 months, 1 year and 2 years post-operatively, to evaluate PRO and HRQoL. Results: The patients underwent three (1–4) AFT procedures, with the injection of 164 ml (median) (range 40–516) fat. Thirty-eight and 34 patients completed the study-specific questionnaire and the SF-36, respectively, both pre-operatively and after 2 years. Sixteen of the 20 items in the SSQ were improved after 2 years, including breast size (p < 0.0001), shape (p < 0.0001), appearance (p < 0.0001), softness of the breast (p = 0.001), pain in the region (p = 0.005), scarring from previous breast surgery (p < 0.001) and willingness to participate in public physical activities (p < 0.001). HRQoL did not largely differ before and after AFT, or between the study group and a reference population. Conclusions: AFT alone or in combination with other corrective surgical procedures, improved PRO after breast-conserving surgery and breast reconstruction in both irradiated and non-irradiated women.

Background: Autologous fat transplantation (AFT) to the breast can correct defects and be a part of a breast reconstruction to achieve a better aesthetic result. The impact of AFT on the radiological evaluation and detection of cancer remains unclarified. The aim of this study is to investigate whether AFT induces lasting modifications.Methods: In the present study, a valuation was performed of 44 breasts from 37 patients examined with mammography and ultrasound before and after autologous fat transplantation. Breast radiologists evaluated the images using a study specific protocol.Results: AFT did not hinder post‐operative assessment of mammograms or ultrasound. No detectable changes with serious clinical impact were found after injections of mean 177 ml (34–516) of fat in one to four sessions. The rate of oil cysts was significantly higher after AFT than pre‐operatively (2.3 vs. 34.1 % p = 0.0013). Significantly more post‐operative oil cysts were detected after injection of larger volumes of fat (144 vs. 243 ml, p = 0.013). No significant differences were found in the post‐operative images regarding age at surgery, follow‐up time, or time from previous breast surgery.Conclusion: AFT does not impair assessment of mammograms and ultrasound in patients who have a history of breast cancer surgery or prophylactic mastectomy.

The aim of this study was to quantify the variation in doses to organs at risk (ipsilateral lung and heart) and the clinical target volume (CTV) in the presence of breast implants. In this retrospective cohort study, patients were identified through the National Breast Cancer Register. Consecutive breast cancer patients undergoing mastectomy between 2009 and 2011 and completing a full course of postmastectomy radiotherapy (PMRT) were eligible. All included patients (n = 818) were identified in the ARIA© oncology information system and further stratified for immediate breast reconstruction (IBR+, n = 162) and no immediate breast reconstruction (IBR-, n = 656). Dose statistics for ipsilateral lung, heart and CTV were retrieved from the system. Radiation plans for patients with chest wall (CW) only (n = 242) and CW plus lymph nodes (n = 576) irradiation were studied separately.

Autologous transplantation of fat, or lipofilling, of the breast can correct deformities after reconstruction and after conservation surgery for cancer. We have made a retrospective evaluation of morbidity and patients' experiences of the method. Forty-four patients have had lipofilling once, twice, or three times (mean transplanted volume 40 ml, range 6–200 ml). One minor complication, a local infection, was treated with antibiotics given orally, and recorded at follow up. A questionnaire was sent to all 44 patients and answered by 43. Twenty-nine of the 43 patients reported improvement of irregularities after lipofilling, 26 reported that the shape of the breast had improved, 26 that the consistency had improved, and 20 that the size had increased postoperatively. Five of the patients reported some adverse effects; one case of liponecrosis that did not need any treatment was found one year postoperatively. No problems were reported at the donor site at follow-up.

Background. The purpose of this study was to evaluate the clinical course of breast reconstruction in patients with personal and family history of breast cancer undergoing contralateral prophylactic mastectomy (CPM) and elucidate the association between reoperation risk and adjuvant treatment. Methods. A descriptive retrospective study of a consecutive series of breast cancer patients who underwent CPM with breast reconstruction at Karolinska University Hospital between 1998 and 2008 was performed. Reoperation was chosen as an outcome variable assessing morbidity and thus documented for each patient and for each reconstructed breast. Regression analyses were performed to evaluate the risk of reoperation after bilateral breast reconstruction. Results. Ninety-one patients underwent CPM during the study period. Their mean age at CPM was 45.3 years (SD =9.4). No contralateral breast cancer was diagnosed after CPM during the median follow-up period of 3.9 years. All women, but two, received an implant based breast reconstruction. The majority (n =75, 82%) underwent CPM with concurrent bilateral breast reconstruction. Overall, after bilateral breast reconstruction 45/75 (60%) required at least one reoperation on the CPM side (n =2, 3%), therapeutic mastectomy (TM) side (n =17, 23%) or both sides (n =26, 33%). In the paired analyses, the probability of reoperation was significantly higher after TM reconstruction as compared to CPM (0.57 vs. 0.37, p =0.001). The mean number of reoperations required for completion of TM and CPM reconstruction was 0.84 and 0.49, respectively (p =0.003). Among all potential risk factors, only radiotherapy was associated with reoperation after bilateral breast reconstruction (odds ratio [OR]: 4.2, 95% CI, 1.3 to 13.6, p =0.015). Conclusions. Breast reconstruction in patients with personal and family history of breast cancer is a complex operation. This study found that the clinical course after bilateral breast reconstruction was predominantly affected by reoperations on the TM side and given radiotherapy was associated with reoperation. Further studies are necessary to examine the possible predictors of unanticipated reoperations in candidates for CPM with breast reconstruction.

A burn injury is an unforeseen event that means physical and psychological trauma for the person afflicted. The trauma experienced by different indivi