The Impact of Fat Graft Reconstructive Surgery on Prognosis in Young Women with Breast Cancer: A Study from the French Insurance Databases.
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BACKGROUND: Fat grafting (FG) is widely used in breast reconstructive surgery (RS) after mastectomy or lumpectomy for breast cancer (BC); however, concerns persist about its oncologic safety. This study evaluated the impact of FG reconstruction compared with other techniques on BC survival in young women. METHODS: The authors identified patients aged 18 to 45 years treated for nonmetastatic BC in the French National Healthcare System Database between January 1, 2010, and December 31, 2018. Patients undergoing FG were matched with patients undergoing other RS on the basis of BC subtype, chemotherapy, radiotherapy, and RS timing after BC surgery. Analyses were stratified on breast surgery (mastectomy or lumpectomy). RESULTS: A total of 50,178 patients were included: 28,260 with luminal tumors, 7982 with triple-negative BC, 7087 with HER2-positive tumors, and 6849 with undefined tumors. In the mastectomy and lumpectomy group, 7333 and 883 patients, respectively, received FG. In the mastectomy group, after matching, FG was associated with better disease-free survival (DFS) (hazard ratio, 0.76 [95% CI, 0.65 to 0.88]) and overall survival compared with patients with other RS. FG also showed improved DFS (hazard ratio, 0.59 [95% CI, 0.51 to 0.69]) compared with patients without any RS. No significant differences in DFS or overall survival were found in the lumpectomy group. CONCLUSIONS: FG appears to improve survival outcomes in young women undergoing mastectomy with or without additional RS. In contrast, no significant impact was observed in the lumpectomy group. These findings suggest that FG can be a safe reconstructive option, particularly after mastectomy. Further research is needed to confirm these results and understand the underlying mechanisms. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.