title: Systematic review: The oncological safety of adipose fat transfer after breast cancer surgery.
abstract: OBJECTIVE
  Oncological concerns have risen around the safety of adipose fat transfer (AFT) after breast cancer surgery. In this article, we present the clinical and molecular evidences, and discuss the current contradiction between them.
  
  
  METHODS
  Every clinical trial and experimental study on AFT and its oncological influences was screened. Between September 2014 and September 2016, 856 articles from four databases were found. 105 core articles were selected.
  
  
  RESULTS
  A total of 18 clinical studies have been published. The loco-regional recurrence (LRR) incidence rates range between 0 and 3.90% per year. For the mastectomy and breast conservative therapy group separately, a LRR per year between 0 and 1.62% and 0-3.90 has been reported, respectively. Some studies included a matched control group and found no significant difference between cases and controls, with the exception of a subgroup of patients with intraepithelial breast carcinoma. Adipose derived mesenchymal stem cells have a potential oncogenic effect on residual cancer cells after breast cancer surgery. Numerous signalling proteins and pathways have been described that can stimulate tumour initiation and growth.
  
  
  CONCLUSIONS
  There is a contradiction between experimental and clinical findings. Numerous adipokines have been discovered that could potentially promote tumour initiation and growth, but clinical studies fail to point out a significant increase in LRR in patients who receive AFT after breast cancer surgery. More prospective studies are needed with a sufficient follow-up time and analysis of some critical factors, such as adjuvant radiotherapy and hormonal therapy, the origin and volume of the injected fat, and genetic influences.
authors.affiliation: University Hospital of Ghent, De Pintelaan 185, 9000 Gent, Belgium. Electronic address: karl.waked@ugent.be.
authors.forename: Karl
authors.initials: K
authors.lastname: Waked
authors.affiliation: University Hospital of Ghent, De Pintelaan 185, 9000 Gent, Belgium. Electronic address: julien.colle@ugent.be.
authors.forename: Julien
authors.initials: J
authors.lastname: Colle
authors.affiliation: Private Medical Center: Maaltebrugge Ghent, Maaltebruggestraat 288, 9000 Gent, Belgium. Electronic address: maarten.doornaert@ugent.be.
authors.forename: Maarten
authors.initials: M
authors.lastname: Doornaert
authors.affiliation: University Hospital of Ghent, De Pintelaan 185, 9000 Gent, Belgium. Electronic address: veronique.cocquyt@ugent.be.
authors.forename: Veronique
authors.initials: V
authors.lastname: Cocquyt
authors.affiliation: University Hospital of Ghent, De Pintelaan 185, 9000 Gent, Belgium. Electronic address: phillip.blondeel@ugent.be.
authors.forename: Phillip
authors.initials: P
authors.lastname: Blondeel
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local
keywords: Adipose fat transfer; Breast cancer; Lipofilling; Oncology; Oncostatin M