If the lipomodeling technique was validated fairly quickly when it was performed for reconstruction after a total mastectomy, in the case of sequelae of conservative treatment (breast having been treated by lumpectomy and radiotherapy), this technique was initially proposed in our team in 2002 within the framework of a very strict protocol, in collaboration with the team of breast oncologists and with the encouragements and kindness of Pr Alain Brémond, who accompanied us to set up a protocol with the best possible oncological safety. In this indication, the risk of coinciding with a new breast cancer or a local recurrence of the first cancer is indeed high (about 1% to 1.5% per year).
The protocol must be very strict in order to limit this risk of coincidence, which could lead to recriminations from the patient if she has not been correctly informed of her spontaneous and natural risk of local recurrence. The protocol includes an accurate breast imaging assessment with mammographic, ultrasound, and MRI assessment by a radiologist specialized in breast imaging. Lipomodeling is usually performed after having been agreed by the specialized radiologist, and also by the oncologist who follows the patient (who has most often referred the patient for the correction of the after-effects of conservative treatment).
Similarly, one year after the intervention, we perform a new breast imaging assessment with mammography and ultrasound; in the case of suspicious images, a microbiopsy is performed by the radiologist. The study we published concluded that the lipomodeling technique was a major advance in the therapeutic arsenal of the management of moderate sequelae of conservative treatment. It makes it possible to restore to the breast a curved shape and flexibility that no other surgical technique had previously provided. Breast imaging is not disturbed by this technique and fat transfer does not interfere with breast monitoring if lipomodelling has been performed according to the rules state-of-art and if breast imaging is performed by a specialized radiologist with good experience.
This indication is, however, the most delicate; and we recommend taking care of these patients as part of a multidisciplinary team whose different members know this subject perfectly, and once the plastic surgeon has passed his learning curve (at least 50 cases of lipomodeling of the breast) in less sensitive indications. According to the SOFCPRE recommendations, it is preferable to reserve this indication for teams highly trained in lipomodeling, diagnosis and breast cancer follow-up in order to limit the risk of coincidence with a possible local recurrence or a possible new breast cancer. The HAS (the french High Authority of Health) report recommends waiting about 2 years after conservative treatment of breast cancer to consider correction by lipomodelling or fat transfer, in order to limit the risk of coinciding with local recurrence (risk of local recurrence is less important after 2 years). Lipomodelling was originally proposed in our team for moderate sequelae of conservative treatment for which no effective technique was available. Then with the experience gained, we can now propose this technique for the important deformities that were previously the use of a musculocutaneous flap as the latissimus dorsi flap, that is currently kept in case of total mastectomy for conservative treatment recurrence (because it is the best solution for total breast reconstruction).