World’s first RCT on lipofilling in breast-conserving surgery shows promising preliminary results

The world’s first randomized controlled trial (RCT) of lipofilling for immediate breast reconstruction in breast-conserving surgery (BCS), conducted by researchers from the University of Hong Kong (HKU), has shown promising preliminary results and continues to recruit patients.

“Lipofilling for breast reconstruction involves harvesting and injection of autologous fat into subcutaneous skin layers, pectoralis major and breast tissue surrounding the cavity after tumour excision. The use of lipofilling for immediate breast reconstruction in BCS is new in Hong Kong,” said Dr George Lee, Specialist in Plastic Surgery, Department of Surgery, HKU.

“The success of conventional oncoplastic breast surgery is limited by the amount of remaining breast tissue after tumour excision. This becomes particularly challenging when the tumour is large or located near the centre of the breast. BCS with lipofilling for breast reconstruction is therefore particularly suitable for patients with smaller breasts, such as Asians,” explained Professor Ava Kwong, Chief of the Division of Breast Surgery, HKU.

“Although there are overseas data supporting the oncologic safety of lipofilling in BCS, no published Asian data or RCT data are currently available,” Kwong noted.  

The largest data set to date supporting the long-term oncologic safety of this approach is a meta-analysis involving 1,063 patients who underwent autologous fat grafting (AFG) at the time of BCS and 900 patients who underwent BCS alone. No significant between-group differences in local recurrence (3 percent for BCS + AFG vs 4.8 percent for BCS alone; p=0.08), metastasis (6.9 vs 4.8 percent; p=0.3) and fat necrosis (p=0.44) were found after an average follow-up of 55.2 and 58.7 months in the respective groups. [Ann Plast Surg 2023;90:106-110]

HKU’s RCT: Preliminary results promising

Supported by overseas data on the long-term oncologic safety of lipofilling for immediate breast reconstruction in BCS, the HKU research team initiated the world’s first RCT to evaluate quality-of-life outcomes and cosmesis of this newer approach, and to provide further evidence on its safety, in patients with early breast cancer in mid-2024.

“As of October 2025, 15 patients had undergone BCS with lipofilling, while three patients were scheduled for the procedure. There were no immediate surgical complications and no unplanned readmissions,” Kwong reported.

Preliminary results from patients who had completed 3-month follow-up (lipofilling group, n=9; control group [conventional BCS], n=13) showed improved breast volume restoration in the lipofilling vs control group. “Psychosocial well-being, satisfaction with breasts, and sexual well-being, as measured by Breast-Q scales, showed slight improvements in the lipofilling vs control group,” said Kwong. “No cancer recurrence occurred during the short-term follow-up.”

Pain scores assessed at 1 day, 2 weeks, and 3 months did not differ significantly between groups.

“The planned follow-up duration is 1 year,” said Dr Billy Cheung of the Division of Breast Surgery, HKU.

Recruitment ongoing

Recruitment for the RCT is ongoing, targeting a total of 48 patients in the lipofilling group and 48 in the control group. Interested parties may contact HKU’s Breast Surgery Research Team at 2255 4765 or brstudy@hku.hk

“Lipofilling for breast reconstruction in BCS may become a standard of care in the future. Our goal is to expand treatment options for patients suitable for BCS, to improve postoperative breast symmetry and natural appearance,” said Kwong.