Timing of autologous fat grafting in implant-based breast reconstruction: Best practices based on systematic review and meta-analysis.

BREAST-Q Patient-reported outcomes Quality of life Second-stage fat grafting Systematic review/meta-analysis Third-stage fat grafting

Journal

Journal of plastic, reconstructive & aesthetic surgery : JPRAS
ISSN: 1878-0539
Titre abrégé: J Plast Reconstr Aesthet Surg
Pays: Netherlands
ID NLM: 101264239

Informations de publication

Date de publication:
11 2023
Historique:
received: 13 06 2023
revised: 14 08 2023
accepted: 08 09 2023
medline: 6 11 2023
pubmed: 5 10 2023
entrez: 5 10 2023
Statut: ppublish

Résumé

Fat grafting is commonly undertaken as a third-stage procedure in patients with staged implant-based breast reconstruction (IBR). However, fat grafting performed during second-stage expander/implant exchange provides faster results without an additional procedure and associated risks (Patel et al., 2020). We previously demonstrated that fat grafting during second-stage expander/implant exchange did not increase clinical complications (Patel et al., 2020). As a corollary, this study investigates patients' satisfaction with second- versus third-stage fat grafting to help establish a set of best practices for the timing of fat grafting in such patients. A review of PubMed/MEDLINE databases (2010-2022) was performed to identify articles investigating the quality of life in patients undergoing second- or third-stage fat grafting after IBR. BREAST-Q scores were pooled using random-effects modeling and the DerSimonian-Laird method. Post-hoc sensitivity analyses were completed using the Hartung-Knapp-Sidik-Jonkman method. The Haldane-Anscombe correction was used for outcomes with low counts. All study analyses adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six studies (216 patients) were included. Pooled random-effects modeling demonstrated no significant changes in BREAST-Q satisfaction with outcome scores when comparing patients who received second- versus third-stage fat grafting (p = 0.178) with results robust to sensitivity analyses. In addition, pooled analyses of the available data demonstrated that second-stage fat grafting did not increase downstream revision surgery needs compared to third-stage fat grafting. In combination with our prior work, this meta-analysis suggests that second-stage fat grafting provides not only equivalent but improved clinical and quality of life outcomes with fewer procedures in patients undergoing expander/IBR.

Sections du résumé

BACKGROUND
Fat grafting is commonly undertaken as a third-stage procedure in patients with staged implant-based breast reconstruction (IBR). However, fat grafting performed during second-stage expander/implant exchange provides faster results without an additional procedure and associated risks (Patel et al., 2020). We previously demonstrated that fat grafting during second-stage expander/implant exchange did not increase clinical complications (Patel et al., 2020). As a corollary, this study investigates patients' satisfaction with second- versus third-stage fat grafting to help establish a set of best practices for the timing of fat grafting in such patients.
METHODS
A review of PubMed/MEDLINE databases (2010-2022) was performed to identify articles investigating the quality of life in patients undergoing second- or third-stage fat grafting after IBR. BREAST-Q scores were pooled using random-effects modeling and the DerSimonian-Laird method. Post-hoc sensitivity analyses were completed using the Hartung-Knapp-Sidik-Jonkman method. The Haldane-Anscombe correction was used for outcomes with low counts. All study analyses adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Six studies (216 patients) were included. Pooled random-effects modeling demonstrated no significant changes in BREAST-Q satisfaction with outcome scores when comparing patients who received second- versus third-stage fat grafting (p = 0.178) with results robust to sensitivity analyses. In addition, pooled analyses of the available data demonstrated that second-stage fat grafting did not increase downstream revision surgery needs compared to third-stage fat grafting.
CONCLUSIONS
In combination with our prior work, this meta-analysis suggests that second-stage fat grafting provides not only equivalent but improved clinical and quality of life outcomes with fewer procedures in patients undergoing expander/IBR.

Identifiants

pubmed: 37797375
pii: S1748-6815(23)00522-3
doi: 10.1016/j.bjps.2023.09.026
pii:
doi:

Types de publication

Meta-Analysis Systematic Review Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

273-279

Informations de copyright

Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors have no relevant financial or non-financial interests to disclose.

Auteurs

Bhagvat Maheta (B)

California Northstate University College of Medicine, Elk Grove, CA, USA.

Pooja S Yesantharao (PS)

Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA.

Kometh Thawanyarat (K)

Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, GA, USA.

Maheen F Akhter (MF)

Central Michigan University College of Medicine, Saginaw, MI, USA.

Mallory Rowley (M)

State University of New York, Upstate Medical University, Syracuse, NY, USA.

Rahim S Nazerali (RS)

Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: rahimn@stanford.edu.

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