The impact of adipose tissue in breast cancer and breast reconstruction
The impact of adipose tissue in breast cancer and breast reconstruction
This thesis of Iris Holt-Kedde explores the role of breast adipose (fat) tissue in both breast cancer and breast reconstruction. Fat tissue is far more than an energy reservoir: it is an active organ that produces inflammatory signals and hormones, influencing tumor development, surgical risk, and even patient recovery and well being.
The first studies examined inflammatory responses in breast adipose tissue. Certain inflammatory patterns, known as crown like structures, were found more frequently in breast cancer patients and were associated with more aggressive tumor types. The research also investigated how body weight, breast cancer, and genetic mutations shape the effect of adipose tissue on breast cancer cells. In particular, obesity was linked to fat cells releasing more stimulatory factors that can activate tumor cells.
The thesis further focuses on breast reconstruction. Several studies demonstrated that autologous reconstruction (using a patient’s own tissue) often results in better long term quality of life than implant based reconstruction. It also showed that the amount of subcutaneous adipose tissue (SAT) and smoking history are better predictors of surgical complications than BMI, even though BMI is still commonly used. Interviews with women with obesity revealed how burdensome weight loss requirements can be when psychosocial factors are overlooked. These women sometimes interpret physicians’ words differently than intended, and such miscommunication can undermine mutual trust.
Overall, this thesis advocates for an integrated approach that brings together biological, surgical, and psychosocial perspectives. By improving our understanding of adipose tissue and offering more personalized patient support, both oncologic safety and reconstructive outcomes can be enhanced.