Fat grafting does carry risk of intra-luminal injection causing necrosis
and infarct of the end organ tissue, which in the head and neck can be
devastating and there are numerous reports of blindness, facial skin
loss, fat embolic syndrome and cerebral infarct (27-29).
Donnenberg et al suggested that ASCs support growth in active
breast cancer cells. In the conclusion of their xenograft studyAFG in breast reconstruction should be deferred until cancer
remission is confirmed. However, fat grafting and ASCs have not
been shown to drive cancer growth in clinical reality, several studies
with big cohorts showed no evidence for an elevation in oncological risk
in AFG (30-32).
Silva et al found no evidence for clinically relevant elevations in
tumour size, proliferation, histologic grade or metastasis in AFGbreast reconstruction in an animal model (33). Moreover, Mazur et al
found no indication for a higher breast cancer risk in ASCsaugmented fat in post-cancer mastectomy and radiation patients (34).
This is sometimes a result of graft retention or simple distribution
over time within the surrounding tissue. Retention rates, however, stay
the same in repeated injections (35). Bourne et al found that retention
rates differed in smokers, who had greater volume retention over
predictable 9 months (35). Further, the studygroup stated thatAFG is less invasive and therefore safer than conventional
reconstruction options (35).
Evidence overall is lacking, and there is no specific research
respectively addressing the oncologic risk profile of AFG in the
head, face and neck. Some publications concentrated on the general
complications of AFG in the head, face and neck, and stated a low
rate of minor complications (36-38). Karmali et al, in their
publication, investigating outcomes of AFG for head and neck
reconstruction and found no evidence for an association with cancer
recurrence (39).