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FAT TRANSPLANTS IN FRANCE

SOFCPRE, which met in National Congress on Wednesday November 24, 2011, addressed the problem of fat transfers in the breast.

PREAMBLE

The fat transfer technique at breast level is currently a recognized technique of great efficiency. To be practiced in accordance with proven scientific data, it must be performed in a surgical environment, by a plastic surgeon or by a surgeon trained specifically for this technique. The practice of this technique outside the surgical framework previously defined is considered dangerous for the patients.

Several recommendations emerged from the discussions and scientific work, depending on the clinical situation:

RECOMMENDATIONS

1 °) In the case of breast reconstructions after total mastectomy, the technique is considered as a surgical option both to improve the quality of the tissues and to participate in the reconstruction of the breast volume. As a recurrence after mastectomy is always possible, the surgeon must carry out a preoperative clinical examination in search of any irregularities in the subcutaneous cellular tissue or skin nodules. An ultrasound of the chest wall may also be requested before the procedure in order to eliminate an active lesion. If in doubt, a prior micro biopsy will be performed. Similarly, any swelling that increases in volume away from the fat transfer should be the subject of an ultrasound study with micro biopsy if there is any doubt.

In the contralateral breast, it is currently not recommended to use this technique outside of multidisciplinary teams that can ensure close and secure senological monitoring.

2 °) In the case of partial breast reconstruction for sequelae of conservative treatment after lumpectomy, taking into account the significant spontaneous risk of local recurrence, and the more difficult clinical diagnosis of a possible local recurrence, the technique can be proposed with the following reservations :

It can only be performed after at least 3 years of clinical and radiological monitoring, by multidisciplinary teams trained in the treatment of breast cancer and its radiological monitoring.

3 °) In the case of breast augmentation for congenital malformations or for aesthetic purposes without cancer pathology, this technique is considered as a surgical option in cases of low risk of coincidence with breast cancer (woman under 35 years old without personal or family history of breast cancer). A preoperative radiological assessment (ultrasound and mammography) carried out by a trained radiologist is considered essential, and its normalcy (ACR1 or ACR2) is the essential prerequisite for performing this intervention.

The SoFCPRE recommends that the patient undertakes to have a reference imaging assessment carried out one year after this intervention, if possible by the same radiologist, and then to remain under regular medical supervision.

SoFCPRE offers corresponding information sheets for all these situations, as well as a national computerized collection of data provided by its members.