2007
卫生署禁止此项手术,主要的理由是容易造成脂肪纤维化以及发生硬块造成乳癌筛检上的困难。
卫生署所本的原因是询问国内整形外科学会所得的;而国内整形外科学会则是遵循1987年美国整形外科医师特别会议(American Society of Plastic and Reconstructive Surgeons Ad-Hoc Committee)的结论。该结论认为:
“The committee is unanimous in deploring the use of autologous fat injection in breast augmentation.
Much of the injected fat will not survive, and the known physiological response to necrosis of this
tissue is scarring and calcification. As a result, detection of early breast carcinoma through xerography
and mammography will become difficult and the presence of disease may go undiscovered.”
主要的意思是说注入的脂肪大部份都不会存活,反而造成疤痕和钙化,而这种钙化和乳癌的钙化在X光上无法辨别,所以本会议全体无异议通过癈止使用自体脂肪注射胸部。然而这项决议在二十年后的今天,开始有人尝试挑战其正确性。
Author Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.
Institution New York, N.Y. From the New York University School of Medicine.
Title Fat Grafting to the Breast Revisited: Safety and Efficacy.[Article]
Source Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.
Abstract
Background: A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper.Methods: This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland’s syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels.
Results: All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure.
Conclusions: Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure.
这十七位病人中后来有一位在注入脂肪侧发现乳癌(另一位是在没有脂肪移植那一侧乳房发现有乳癌,所以真正有关的只有一位),但美国妇女终其一生得到乳癌的机率是 1/7 (台湾则为 1/11),所以他的病人并不算机会特别高。因此,Dr. Coleman 认为不应该再禁止做自体脂肪注入胸部的手术了。
Dr. Coleman 在文章中提到了一些理由驳斥1987年美国整外特别会议的结论,我整理如下:
1. 靠着技术上和知识上的改进,我们现在可以改善注入脂肪的存活,减少感染、脂肪腐烂(necrosis)、以及钙化的情形
2. 任何一项乳房的手术如缩乳术、乳房切片手术、水袋/矽胶植入隆胸等等都有可能造成胸部钙化的情形,为何不禁止这些手术而独禁脂肪注入呢?
3. 现代的乳房摄影术足以分辨脂肪钙化或是乳癌钙化,所以不会造成乳癌侦测的延迟。他自己二位病人得乳癌就很早期便侦测到。
2015
2015年7月PRS刊出了一篇文章把所有鼓吹自体脂肪隆乳的医师狠狠地打脸
Author: Kamat, Pranitha Ph.D.; Schweizer, Riccardo M.D.; Kaenel, Philip Ph.D.; Salemi, Souzan Ph.D.; Calcagni, Maurizio M.D.; Giovanoli, Pietro M.D.; Gorantla, Vijay S. M.D., Ph.D.; Eberli, Daniel M.D., Ph.D.; Andres, Anne-Catherine M.D.; Plock, Jan A. M.D.
Title: Human Adipose-Derived Mesenchymal Stromal Cells May Promote Breast Cancer Progression and Metastatic Spread
Source: Plastic and Reconstructive Surgery 2015:136(1);76-84.
Abstract
Background: Stem cell–enriched fat grafting has been proposed as a potential therapy for reconstructive, restorative, or enhancement-related procedures of the breast. Its role in postoncologic breast reconstruction is still emerging, with concerns about safety. The authors investigated the dose-dependent interaction between human adipose-derived mesenchymal stromal cells (AD-MSCs) and human breast cancer cell (BCC) lines [MDA-MB-231 (MDA) and MCF-7 (MCF)] focusing on tumor microenvironment, tumor growth, and metastatic spread.Methods: Adipose-derived mesenchymal stromal cell influence on viability and factor expression [regulated on activation, normal T cell expressed and secreted (RANTES), tumor necrosis factor-α, and eotaxin) of breast cancer cells was studied in vitro using direct and indirect co-culture systems. Groups were formed according to adipose-derived mesenchymal stromal cell–to–cancer cell number ratio [MDA/MCF only, AD-MSClow/(MDA/MCF), and AD-MSChigh/(MDA/MCF)]. A humanized orthotopic murine cancer model was used to evaluate breast cancer progression and metastasis (n = 10/group). Cells were injected into the mammary pad in different ratios and animals were monitored over 42 days. Microdialysis was performed to analyze RANTES levels in the tumor microenvironment (days 21 and 42). Primary and metastatic tumors were weighed and analyzed for oncogene, growth factor, and metastatic marker expression.
Results: MDA cell viability increased from 45.5 percent to 95.5 percent in presence of adipose-derived mesenchymal stromal cells in vitro. In vivo, animals with AD-MSChigh showed increased mean tumor weight (MDA, p < 0.01; MCF versus controls, p < 0.05) and metastatic occurrence (40 percent in MDA; 30 percent in MCF versus 0 percent in controls). Cytokine analysis revealed switching of MCF tumor phenotype to a more malignant type in the presence of adipose-derived mesenchymal stromal cells.
Conclusion: Human adipose-derived mesenchymal stromal cells may promote progression and metastatic spread in breast cancer through a switch to a more malignant phenotype with worse prognosis.
Kamat等人把脂肪干细胞和人类乳癌细胞一起培养,结果发现乳癌细胞会被活化;而且增加了30~40%的转移机率。吓死人的结论。当然这不是拿而是用老鼠做的实验,不过见微知著,如果读者有乳癌病史或者是属于乳癌的高危险群,我建议妳千万不要做这项手术。事实上,早在2009年左右我就看过一位乳房良性肿瘤患者在台北东区某诊所做完自体脂肪隆乳一个月后良性肿瘤突然变大好几倍造成医纠。
2017
2年过去了,2017年11月 PRS推出一本专刊讨论乳房手术后重建
The “Advances in Breast Reconstruction” Supplement,其中一篇文章 Fat Grafting to the Breast: Clinical Applications and Outcomes for Reconstructive Surgery 提到脂肪移植到乳癌术后病人的安全性。
Kristen et al. 发现在局部复发的比例上有脂肪移植和没有的病人并没有差别;
Gale et al. 等人追踪328位病人达88个月之久,也发现局部,区域,及远处转移的比例有无脂肪移植并没有差别;
Khouri et al. 等人则追踪488位病人达7年之久,发现局部/区域复发比例在0.5%左右
总之,以现在有的证据看来脂肪移植到乳癌术后病人是安全的。