BACKGROUND: Breast-conserving treatment (BCT) leads to a progressive and deteriorating breast deformity. Fatgrafting is ideal for breast reconstruction after BCT. The most frequently utilized technique for fat processing is centrifugation. The PureGraft device (Cytori Therapeutics, San Diego, CA, USA) is a new method that involves washing and filtering the fat to prepare the graft. We compared the subjective and objective outcomes of two fat-processing methods, centrifugation and PureGraft filtration. METHODS: Thirty patients underwent breast reconstruction performed by a single surgeon (OM) after BCT in our department between April 2011 and September 2012. The patients were preoperatively divided into two groups randomly: 15 received fatgrafts processed by centrifugation, and 15 received fatgrafts processed by washing in PureGraft bags. The patients were followed up for 12 to 30 months. To measure the subjective outcome, we distributed the BREAST-Q questionnaire to all the patients both preoperatively and 1 year postoperatively. The BCCT.core software evaluated the objective outcome of breast reconstruction by fatgrafting. RESULTS: The Breast-Q results indicated a tremendous improvement in the modules "Satisfaction with Breast" and "Psychosocial Well-being". The "Sexual Well-being" scale also improved. Only the module "Satisfaction with Breasts" significantly differed between groups; patients treated with the PureGraft fat exhibited better outcomes. The BCCT.core results did not significantly differ between the groups. CONCLUSION: One year postoperatively, the outcomes of the use of PureGraft bags or centrifugation to process fat for breast reconstruction after BCT did not differ. The unpredictability of the results following fatgrafting procedures is likely due to interindividual differences with yet-undisclosed causes.

Department of Plastic Surgery Bulovka Hospital 1st Medical Faculty of Charles University Prague Budinova 2 Prague 8 180 00 Czech Republic

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Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R. Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;9804:1707–1716. PubMed PMC

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–1232. doi: 10.1056/NEJMoa020989. PubMed DOI

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–1241. doi: 10.1056/NEJMoa022152. PubMed DOI

Irwig L, Bennetts A. Quality of life after breast conservation or mastectomy: a systematic review. Aust N Z J Surg. 1997;67:750–754. doi: 10.1111/j.1445-2197.1997.tb04573.x. PubMed DOI

Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol. 2005;31:817–823. doi: 10.1016/j.ejso.2005.05.010. PubMed DOI

Johansen J, Overgaard J, Rose C, Engelholm SA, Gadeberg CC, Kjaer M, Kamby C, Juul-Christensen J, Blichert-Toft M, Overgaard M. Danish Breast Cancer Cooperative Group (DBCG) and the DBCG Radiotherapy Committee. Cosmetic outcome and breast morbidity in breast-conserving treatment - results from the Danish DBCG-82TM national randomized trial in breast cancer. Acta Oncol [Internet] 2002;41:369–380. PubMed

Kelly DA, Wood BC, Knoll GM, Chang SC, Crantford JC, Bharti GD, Levine EA, Thompson JT. Outcome analysis of 541 women undergoing breast conservation therapy. Ann Plast Surg. 2012;68:435–437. doi: 10.1097/SAP.0b013e31823b6ae3. PubMed DOI

Momoh AO, Ahmed R, Kelley BP, Aliu O, Kidwell KM, Kozlow JH, Chung KC. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol. 2013, Jan;21(1):118–124. doi:10.1245/s10434-013-3284-z. Epub 2013 Oct 1. PubMed PMC

Ersek RA. Transplantation of purified autologous fat: a 3-year follow-up is disappointing. Plast Reconstr Surg. 1991;87:219–227. doi: 10.1097/00006534-199102000-00001. discussion 228. PubMed DOI

Chan CW, McCulley SJ, Macmillan RD. Autologous fat transfer - a review of the literature with a focus on breast cancer surgery. J Plastic Reconstruc Aesthetic Surgery. 2008;61:1438–1448. doi: 10.1016/j.bjps.2008.08.006. PubMed DOI

Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg. 2007;119:775–785. doi: 10.1097/01.prs.0000252001.59162.c9. PubMed DOI

Rietjens M, De Lorenzi F, Rossetto F, Brenelli F, Manconi A, Martella S, Intra M, Venturino M, Lohsiriwat V, Ahmed Y, Petit JY. Safety of fat grafting in secondary breast reconstruction after cancer. J Plastic Reconstruc aesthetic Surgery. 2011;64:477–483. doi: 10.1016/j.bjps.2010.06.024. PubMed DOI

Rigotti G, Marchi A, Galie M, Baroni G, Benati D, Krampera M, Pasini A, Sbarbati A. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg. 2007;119:1409–1422. doi: 10.1097/01.prs.0000256047.47909.71. discussion 1423–1424. PubMed DOI

Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg. 2006;118(3 Suppl):108S–120S. PubMed

Lindroos B, Suuronen R, Miettinen S. The potential of adipose stem cells in regenerative medicine. Stem Cell Rev. 2011;7:269–291. doi: 10.1007/s12015-010-9193-7. PubMed DOI

Pallua N, Pulsfort AK, Suschek C, Wolter TP. Content of the growth factors bFGF, IGF-1, VEGF, and PDGF-BB in freshly harvested lipoaspirate after centrifugation and incubation. Plast Reconstr Surg. 2009;123:826–833. doi: 10.1097/PRS.0b013e318199ef31. PubMed DOI

Conde-Green A, Wu I, Graham I, Chae JJ, Drachenberg CB, Singh DP, Holton L 3rd, Slezak S, Elisseeff J. Comparison of 3 techniques of fat grafting and cell-supplemented lipotransfer in athymic rats: a pilot study. Aesthetic Surgery J Am Soc Aesthetic Plastic Surgery. 2013;33:713–721. doi: 10.1177/1090820X13487371. PubMed DOI

Conde-Green A, Baptista LS, de Amorin NFG, de Oliveira ED, da Silva KR, Pedrosa CDSG, Borojevic R, Pitanguy I. Effects of centrifugation on cell composition and viability of aspirated adipose tissue processed for transplantation. Aesthetic Surgery J Am Soc Aesthetic Plastic Surgery. 2010;30:249–255. doi: 10.1177/1090820X10369512. PubMed DOI

Conde-Green A, de Amorim NFG, Pitanguy I. Influence of decantation, washing and centrifugation on adipocyte and mesenchymal stem cell content of aspirated adipose tissue: a comparative study. Br J Plast Surg. 2010;63:1375–1381. PubMed

Botti G, Pascali M, Botti C, Bodog F, Cervelli V. A clinical trial in facial fat grafting: filtered and washed versus centrifuged fat. Plast Reconstr Surg. 2011;127:2464–2473. doi: 10.1097/PRS.0b013e3182131d5d. PubMed DOI

Gir P, Brown SA, Oni G, Kashefi N, Mojallal A, Rohrich RJ. Fat grafting: evidence-based review on autologous fat harvesting, processing, reinjection, and storage. Plast Reconstr Surg. 2012;130:249–258. doi: 10.1097/PRS.0b013e318254b4d3. PubMed DOI

Ozkaya O, Egemen O, Barutca SA, Akan M. Long-term clinical outcomes of fat grafting by low-pressure aspiration and slow centrifugation (Lopasce technique) for different indications. J Plast Surg Hand Surg. 2013;47:394–398. doi: 10.3109/2000656X.2013.771585. PubMed DOI

Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124:345–353. doi: 10.1097/PRS.0b013e3181aee807. PubMed DOI

Pusic AL, Chen CM, Cano S, Klassen A, McCarthy C, Collins ED, Cordeiro PG. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg. 2007;120:823–837. doi: 10.1097/01.prs.0000278162.82906.81. discussion 838–839. PubMed DOI

Klassen AF, Pusic AL, Scott A, Klok J, Cano SJ. Satisfaction and quality of life in women who undergo breast surgery: a qualitative study. BMC Womens Health. 2009;9:11. doi: 10.1186/1472-6874-9-11. PubMed DOI PMC

Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg. 2012;129:293–302. doi: 10.1097/PRS.0b013e31823aec6b. PubMed DOI

Cardoso MJ, Cardoso J, Amaral N, Azevedo I, Barreau L, Bernardo M, Christie D, Costa S, Fitzal F, Fougo JL, Johansen J, Macmillan D, Mano MP, Regolo L, Rosa J, Teixeira L, Vrieling C. Turning subjective into objective: The BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment. Breast. 2007;16:456–461. doi: 10.1016/j.breast.2007.05.002. PubMed DOI

Hill-Kayser CE, Chacko D, Hwang W-T, Vapiwala N, Solin LJ. Long-term clinical and cosmetic outcomes after breast conservation treatment for women with early-stage breast carcinoma according to the type of breast boost. Int J Radiat Oncol Biol Phys. 2011;79:1048–1054. doi: 10.1016/j.ijrobp.2009.12.026. PubMed DOI

Rose MA, Olivotto I, Cady B, Koufman C, Osteen R, Silver B, Recht A, Harris JR. Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results. Rchives Surgery (Chicago Ill 1960) 1989;124:153–157. doi: 10.1001/archsurg.1989.01410020023002. PubMed DOI

Hill-Kayser CE, Vachani C, Hampshire MK, Di Lullo GA, Metz JM. Cosmetic outcomes and complications reported by patients having undergone breast-conserving treatment. Int J Radiat Oncol Biol Phys. 2012;83:839–844. doi: 10.1016/j.ijrobp.2011.08.013. PubMed DOI

Kucerova L, Skolekova S, Matuskova M, Bohac M, Kozovska Z. Altered features and increased chemosensitivity of human breast cancer cells mediated by adipose tissue-derived mesenchymal stromal cells. BMC Cancer. 2013;13:535. doi: 10.1186/1471-2407-13-535. PubMed DOI PMC

Petit JY, Botteri E, Lohsiriwat V, Rietjens M, De Lorenzi F, Garusi C, Rossetto F, Martella S, Manconi A, Bertolini F, Curigliano G, Veronesi P, Santillo B, Rotmensz N. Locoregional recurrence risk after lipofilling in breast cancer patients. Ann Oncol. 2012;23:582–588. doi: 10.1093/annonc/mdr158. PubMed DOI

Rigotti G, Marchi A, Stringhini P, Baroni G, Galie M, Molino AM, Mercanti A, Micciolo R, Sbarbati A. Determining the oncological risk of autologous lipoaspirate grafting for post-mastectomy breast reconstruction. Aesthetic Plast Surg. 2010;34:475–480. doi: 10.1007/s00266-010-9481-2. PubMed DOI