2007
衛生署禁止此項手術，主要的理由是容易造成脂肪纖維化以及發生硬塊造成乳癌篩檢上的困難。
衛生署所本的原因是詢問國內整形外科學會所得的；而國內整形外科學會則是遵循1987年美國整形外科醫師特別會議(American Society of Plastic and Reconstructive Surgeons Ad-Hoc Committee)的結論。該結論認為:
“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.”
主要的意思是說注入的脂肪大部份都不會存活，反而造成疤痕和鈣化，而這種鈣化和乳癌的鈣化在X光上無法辨別，所以本會議全体無異議通過癈止使用自体脂肪注射胸部。然而這項決議在二十年後的今天，開始有人嘗試挑戰其正確性。
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.
這十七位病人中後來有一位在注入脂肪側發現乳癌(另一位是在沒有脂肪移植那一側乳房發現有乳癌，所以真正有關的只有一位)，但美國婦女終其一生得到乳癌的機率是 1/7 (台灣則為 1/11)，所以他的病人並不算機會特別高。因此，Dr. Coleman 認為不應該再禁止做自体脂肪注入胸部的手術了。
Dr. Coleman 在文章中提到了一些理由駁斥1987年美國整外特別會議的結論，我整理如下：
1. 靠著技術上和知識上的改進，我們現在可以改善注入脂肪的存活，減少感染、脂肪腐爛(necrosis)、以及鈣化的情形
2. 任何一項乳房的手術如縮乳術、乳房切片手術、水袋/矽膠植入隆胸等等都有可能造成胸部鈣化的情形，為何不禁止這些手術而獨禁脂肪注入呢？
3. 現代的乳房攝影術足以分辨脂肪鈣化或是乳癌鈣化，所以不會造成乳癌偵測的延遲。他自己二位病人得乳癌就很早期便偵測到。
2015
2015年7月PRS刊出了一篇文章把所有鼓吹自體脂肪隆乳的醫師狠狠地打臉
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等人把脂肪幹細胞和人類乳癌細胞一起培養，結果發現乳癌細胞會被活化；而且增加了30~40%的轉移機率。嚇死人的結論。當然這不是拿而是用老鼠做的實驗，不過見微知著，如果讀者有乳癌病史或者是屬於乳癌的高危險群，我建議妳千萬不要做這項手術。事實上，早在2009年左右我就看過一位乳房良性腫瘤患者在台北東區某診所做完自體脂肪隆乳一個月後良性腫瘤突然變大好幾倍造成醫糾。
2017
2年過去了，2017年11月 PRS推出一本專刊討論乳房手術後重建
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術後病人的安全性。
Kristen et al. 發現在局部復發的比例上有脂肪移植和沒有的病人並沒有差別；
Gale et al. 等人追蹤328位病人達88個月之久，也發現局部，區域，及遠處轉移的比例有無脂肪移植並沒有差別；
Khouri et al. 等人則追蹤488位病人達7年之久，發現局部/區域復發比例在0.5%左右
總之，以現在有的證據看來脂肪移植到乳癌術後病人是安全的。
