Caution must be a hard point in the use of PRP. But the most important thing in PRP function is the behavior. There are a lot of papers showing individual factors action in vitro but the relationship between each factor and his behavior is really the key point. The experience of our group shows a great security of use of PRP in articulations and tissues with lesions in cartilage, muscles, tendons, ligaments and skin. Cell therapy with stem cells are actually an indication of reconstruction in breast tumor in reconstructive and plastic surgery groups of our city.

Use of PRP could be a treatment to improve injured tissues including tumor excision site. It's obvious that nobody must to use biologic treatments in active tumors but any paper demonstrate any case of induced tumor by this treatment.

I dont work in this field but cuation is always a good idea

There are some papers related to risk factors regarding PRP application during breast reconstruction at a tumor excision site. However, the results from these studies are not conclusive so more studies will be need to clarify this point and to establish some guidelines in this field avoiding unnecessary risks in these patients.

Caution must be a hard point in the use of PRP. But the most important thing in PRP function is the behavior. There are a lot of papers showing individual factors action in vitro but the relationship between each factor and his behavior is really the key point. The experience of our group shows a great security of use of PRP in articulations and tissues with lesions in cartilage, muscles, tendons, ligaments and skin. Cell therapy with stem cells are actually an indication of reconstruction in breast tumor in reconstructive and plastic surgery groups of our city.

Use of PRP could be a treatment to improve injured tissues including tumor excision site. It's obvious that nobody must to use biologic treatments in active tumors but any paper demonstrate any case of induced tumor by this treatment.

I, personally, was following some data in the literature and made controlled application of PRP in simple bone cyst in 2 cases. Both with disastrous results. Be very, very cautious if you try to apply in tumors...

An important point here is whether the breast that developed cancer has undergone mastectomy for resection; ie. removal of all breast parenchyma. This is a different discussion to the scenario where the breast cancer has been resected by lumpectomy; ie. not undergone removal of all breast parenchyma. In these two scenarios, the bed in which the fat is grafted +/- growth factors is therefore either devoid of breast tissue or has breast tissue present.

A second point is that this has, to some extent, been discussed by the American Society of Plastic Surgeons as well as the British Society of Plastic, Reconstructive and Aesthetic Surgeons (together with Societies/representatives from other related disciplines). Whilst they do not specifically discuss growth factors, clinically it is likely that fat grafts harvested surgically harbour growth factors anyway. Indeed, any autologous breast reconstruction (eg. DIEP/TRAM/LD/etc flap) will harvest vascularised fat and growth factors/plasma too.

Some quotes follow, but please do read the full articles and refer to the original articles that they cite. Also, please note that these Guidelines were produced a couple of years ago so won't be totally up to date.

From the BAPRAS document (http://www.bapras.org.uk/downloaddoc.asp?id=666):

- "There is no evidence that the risk of local recurrence in breast cancer patients is increased after lipomodelling 5,7,8,9,10."

- "Whilst long-term follow up studies have suggested that fat grafting does not lead to an increased local recurrence rate or effect clinical or mammographic surveillance these series are small and additional data is required 5,6,7,8,9,10,27,28,34,35,36,37,38,39."

From the ASAPS document (http://www.plasticsurgery.org/Documents/medical-professionals/health-policy/guiding-principles/2012Post-MastectomyFatGraft-FatTransferASPSGuidingPrinciples.pdf):

- "Evidence suggests that in post-mastectomy breast reconstruction patients, fat grafting does not increase the risk of breast cancer recurrence.2, 7, 10, 13-14"

I do agree with Dr Wallace about a rational discrimination between patients with a partial resection of the breast tissue who are at least theoretically more prone to be stimulated by those factors retained in the lipofilled tissue and those patients who have no residual tissue at all, golden standard to be treated with implant and lipo,

A blurred vision is in my opinion that patient who had a partial mastectomy , radiotherapy and is a potential good candidate for a correction with lipofilling ......

PRP or injection boost of growth factors in an area at risk for local relapse is basically a contradiction in terms of biology and medicine research in breast cancer,

We have found no higher risk for the conventional lipofilling "after total mastectomy" (published data), but I think the safer use of fat must be taken apart of the repeated injections of GF here discussed. The risk of local recurrence is known to be  present after partial resections (especially for DCIS, a higher risk was reported in literature after fat injections by Petit et al). The mastectomy site shows very small rates of local relapse, but this is not true for all types of breast cancer. There are molecular patterns of carcinoma that overcome the 20% of risk for relapse. A medical doctor must be conscious about the inherent clinical and biological patterns of each patient before "unnecessary" PRP injections. In particular, if this treatment is not performed and monitored in a Cancer Center. That is my cautious opinion.