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Sowa Y, Nakayama I, Toyohara Y, Higai S, Yoshimura K. Pain-relieving Effects of Autologous Fat Grafting in Breast Cancer Surgery: A Scoping Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5909. [PMID: 38881960 PMCID: PMC11177809 DOI: 10.1097/gox.0000000000005909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/30/2024] [Indexed: 06/18/2024]
Abstract
Background Chronic pain is relatively common after breast cancer surgery, including breast reconstruction. Autologous fat grafting (AFG) has gained attention as a novel method for breast reconstruction, and recent clinical studies have also shown effects of AFG on alleviation of chronic pain after breast cancer surgery. Our objective was to conduct a scoping review of studies that have examined these effects with clearly defined clinical outcomes. Methods A literature search was conducted using three databases: PubMed, MEDLINE, and Google Scholar, following PRISMA guidelines and the Arkesy and O'Malley framework. The search focused on clinical studies of the effects of AFG on chronic pain after breast cancer surgery. All studies reporting functional outcomes, return to work, and secondary surgery in a repeat operation were identified. Results Of the 148 studies identified in the search, 11 studies with a total of 684 patients were included in the review. The average volume of fat grafted was approximately 128 mL over an average of 1.6 sessions. The most common time point for assessment was 1 year post-AFG. In all studies with an evidence level of 3 or lower, AFG showed positive results in alleviating pain after breast cancer surgery. However, one of the three randomized controlled trials did not show clinically significant effects. Conclusions Most of the studies examined in this review suggested pain-relieving effects of AFG. However, there was one randomized controlled trial in which these effects were not confirmed, indicating a need for further accumulation of cases and performance of new, well-designed randomized controlled trials.
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Affiliation(s)
- Yoshihiro Sowa
- From the Department of Plastic Surgery, Jichi Medical University, Shimotsuke City, Japan
| | - Ichiro Nakayama
- Department of Breast Surgery, Kyoto Miniren Chuo Hospital, Kyoto, Japan
| | - Yoshihiro Toyohara
- From the Department of Plastic Surgery, Jichi Medical University, Shimotsuke City, Japan
| | - Shino Higai
- From the Department of Plastic Surgery, Jichi Medical University, Shimotsuke City, Japan
| | - Kotaro Yoshimura
- From the Department of Plastic Surgery, Jichi Medical University, Shimotsuke City, Japan
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Chen J, Alghamdi AA, Wong CY, Alnaim MF, Kuper G, Zhang J. The Efficacy of Fat Grafting on Treating Post-Mastectomy Pain with and without Breast Reconstruction: A Systematic Review and Meta-Analysis. Curr Oncol 2024; 31:2057-2066. [PMID: 38668055 PMCID: PMC11049271 DOI: 10.3390/curroncol31040152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Post-mastectomy pain syndrome (PMPS), characterized by persistent pain lasting at least three months following mastectomy, affects 20-50% of breast surgery patients, lacking effective treatment options. A review was conducted utilizing EMBASE, MEDLINE, and all evidence-based medicine reviews to evaluate the effect of fat grafting as a treatment option for PMPS from database inception to 29 April 2023 (PROSPERO ID: CRD42023422627). Nine studies and 812 patients in total were included in the review. The overall mean change in visual analog scale (VAS) was -3.6 in 285 patients following fat grafting and 0.5 in 147 control group patients. There was a significant reduction in VAS from baseline in the fat grafting group compared to the control group, n = 395, mean difference = -2.17 (95% CI, -2.95 to -1.39). This significant improvement was also noted in patients who underwent mastectomy without reconstruction. Common complications related to fat grafting include capsular contracture, seroma, hematoma, and infection. Surgeons should consider fat grafting as a treatment option for PMPS. However, future research is needed to substantiate this evidence and to identify timing, volume of fat grafting, and which patient cohort will benefit the most.
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Affiliation(s)
- Jeffrey Chen
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.C.); (C.Y.W.)
| | | | - Chi Yi Wong
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.C.); (C.Y.W.)
| | - Muna F. Alnaim
- College of Medicine, King Faisal University, Al Ahsa 31982, Saudi Arabia;
| | - Gabriel Kuper
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Jing Zhang
- Division of Plastics and Reconstructive Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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Samuels S, Adeboye T, Zafar AQ, Katsura C, Izard C, Shahrokhi N, Rahman S. Autologous Fat Grafting for Post-mastectomy Pain Syndrome: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e49017. [PMID: 38024082 PMCID: PMC10676735 DOI: 10.7759/cureus.49017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
Fat grafting has been described as a potential treatment for post-mastectomy pain syndrome (PMPS) following oncological breast surgery. The study's aim was to compare and contrast the current literature using a systematic review and meta-analysis to quantify the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Databases, including MEDLINE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched. Data synthesis was conducted using Review Manager 5.4 (Cochrane Collaboration, London, UK), with 95% confidence intervals. All randomised controlled trials (RCT) and observational studies comparing lipofilling for PMPS were included. A total of six studies met the inclusion criteria with five articles being used in data analysis for the mean percentage reduction in visual analogue scale (VAS) score. The primary outcome measure was the mean percentage reduction in the VAS pain score. Secondary outcomes included the Neuropathic Pain Symptom Inventory (NPSI) and the quality of life assessments post treatment. Overall, a total of 266 patients received fat transfer for PMPS, and 164 were in the control group. The mean percentage reduction in VAS score was 19.8 (10.82, 28.82; p < 0.0001). Secondary outcomes, including health-related quality of life, showed good outcomes post fat transfer. This involved breast softness, cosmesis, and psychosocial well-being. The results from this meta-analysis suggest that autologous fat grafting is an efficacious treatment for reducing pain caused by PMPS. The authors suggest more high-quality trials are needed to enhance the current evidence base.
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Affiliation(s)
- Sabrina Samuels
- Plastic and Reconstructive Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
| | - Teniola Adeboye
- Plastic and Reconstructive Surgery, Mid and South Essex NHS Foundation Trust, Essex, GBR
| | | | - Chie Katsura
- Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | - Charlie Izard
- Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
| | - Nazanin Shahrokhi
- Plastic and Reconstructive Surgery, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Shafiq Rahman
- Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
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Avila F, Torres-Guzman R, Maita K, Garcia JP, De Sario GD, Borna S, Ho OA, Forte AJ. A Review on the Management of Peripheral Neuropathic Pain Following Breast Cancer. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:761-772. [PMID: 37927491 PMCID: PMC10624189 DOI: 10.2147/bctt.s386803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
Postmastectomy pain syndrome (PMPS) is a common and debilitating form of postsurgical pain with neuropathic characteristics, presenting as burning, stabbing, or pulling sensations after mastectomy, lumpectomy, or other breast procedures. With a prevalence of 31%, the risk factors for PMPS include younger age, psychosocial factors, radiotherapy, axillary lymph node dissection, and a history of chronic pain. This review evaluates the pharmacological and surgical options for managing PMPS. Pharmacological treatment options include antidepressants, gabapentinoids, levetiracetam, capsaicin, and topical lidocaine. Procedural and surgical options include fat grafting, nerve blocks, radiofrequency ablation, peripheral nerve surgery, serratus plane block, and botulinum toxin injections. Despite the variety of therapeutic options available for patients, further randomized trials are required to conclude whether these treatments reduce the intensity of neuropathic pain in patients with PMPS. In particular, comparative studies and the inclusion of patients across a range of pain intensities will be essential to developing a treatment algorithm for PMPS. In conclusion, current management for these patients should be tailored to their individual requirements.
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Affiliation(s)
- Francisco Avila
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo Torres-Guzman
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Karla Maita
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gioacchino D De Sario
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Sahar Borna
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
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Salati SA, Alsulaim L, Alharbi MH, Alharbi NH, Alsenaid TM, Alaodah SA, Alsuhaibani AS, Albaqami KA. Postmastectomy Pain Syndrome: A Narrative Review. Cureus 2023; 15:e47384. [PMID: 38021812 PMCID: PMC10657609 DOI: 10.7759/cureus.47384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Postmastectomy pain syndrome is a very common disorder in breast cancer survivors. The impact on the quality of patients' lives is significantly adverse. The precise pathophysiology has not been determined as yet though various risk factors have been identified that make the patient vulnerable. Required preoperative work includes the identification and possible elimination of risk factors. Treatment is multidisciplinary involving surgical and non-surgical modalities. There is a great scope of research in this field.
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Affiliation(s)
- Sajad Ahmad Salati
- General Surgery, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Lamees Alsulaim
- Surgery, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Mariyyah H Alharbi
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Norah H Alharbi
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Thana M Alsenaid
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Shoug A Alaodah
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Abdulsalam S Alsuhaibani
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Khalid A Albaqami
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
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Kei KF, Chen C, Kang YN. Further Studies are Still Needed to Test Whether Fat Grafting Reduce Postmastectomy Pain. Aesthetic Plast Surg 2023; 47:2199-2202. [PMID: 37202482 DOI: 10.1007/s00266-023-03351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND To test the effects of autologous fat grafting for reducing postmastectomy pain is important since post-operative pain bothers many patients with postmastectomy pain syndrome (PMPS), and one session autologous fat grafting for this condition is also investigated in some studies. Most of them show the positive effect on pain control, but the most recent randomized controlled trial (RCT) does not. The relatively small sample size with incomplete follow-up in the RCT might limit the certainty of evidence, and cases for the final analysis is lesser than expected numbers by sample size determination. Besides, there is no futility analysis to show the non-significant finding could be conclusive evidence. To check the conclusiveness of comparative evidence on this topic becomes a critical task for guiding clinicians and further studies in the future, therefore the purpose of this letter is to test whether evidence on fat grafting for alleviating pain amongst patients with PMPS is conclusive using sequential analysis. METHODS This supplementary analysis used the data from the comparative evidence on fat grafting for PMPS based on the most recent RCT and previous systematic reviews. Complete data of pain score of two comparative studies from Italy were presented in a pooled report, therefore, this letter used data of pooled report for the Italy studies. Pooled mean difference (MD) in pain score between fat grafting and control groups was based on random-effects model. Quantitative synthesis consisted of cumulative meta-analysis and leave-one out sensitivity analysis due to heterogeneity from clinical setting across the included studies. Then, sequential analysis was further done with a conservative effect size (standardized mean difference = 0.2), type I error (α = 0.05), and power of 0.80 based on O'Brien Flemming method. All analyses were carried out using R version 4.1 via RStudio for Microsoft Windows. RESULTS Sequential analysis exhibited a non-significant and inconclusive evidence on fat grafting for pain control in PMPS if this synthesis included the newest RCT. Although the pooled result with unmet expectation of z-score in sequential analysis, it might not fall in futility. If the newest RCT was removed from the synthesis, sequential analysis showed significant but inconclusive evidence on fat grafting for pain control in PMPS. CONCLUSION There is no conclusive evidence to support or refuse the use of fat grafting in postmastectomy pain control. This topic is worthy of further studies in investigating the effects of fat grafting on pain control amongst patients with PMPS. LEVEL OF EVIDENCE V This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Kin Fung Kei
- Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Taipei, 11696, Taiwan.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Taipei, 11696, Taiwan.
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Taipei, 11696, Taiwan.
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Autologous Fat Grafting as Treatment of Postmastectomy Pain Syndrome: A Randomized Controlled Trial. Plast Reconstr Surg 2023; 151:520e-521e. [PMID: 36730330 DOI: 10.1097/prs.0000000000009940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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8
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Reply: Autologous Fat Grafting as Treatment of Postmastectomy Pain Syndrome: A Randomized Controlled Trial. Plast Reconstr Surg 2023; 151:521e-522e. [PMID: 36730355 DOI: 10.1097/prs.0000000000009941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Treating Pain and Fat Necrosis after Breast Cancer Surgery with Fat Grafting: Is one Session Enough? Aesthetic Plast Surg 2022; 46:2677-2688. [PMID: 35804155 DOI: 10.1007/s00266-022-02983-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic pain after breast cancer surgery is affecting up to 60% of patients, causing significant morbidity to patients. Lately, fat grafting has been applied as a therapy for chronic neuropathic pain. METHODS We report a series of eighteen patients, who were treated for pain after breast cancer surgery. Twelve patients had a breast conserving therapy, two a mastectomy and four an autologous flap-based reconstruction. While most presented with neuropathic pain, six patients had fat necrosis in their history. Most patients presented with severe pain (77%) and were treated with fat grafting sessions, performed by water-assisted liposuction. RESULTS All patients responded to the interventions; the median number of fat grafting sessions was 2, the median duration of the interventions was 4 months, and the median follow-up period was 56.5 months. The median pain prior to the fat grafting procedure had an intensity of 8 (range 7-9) numeric rating scale points; after the first intervention, this was reduced to 4 (range 2.3-5.8); and after the second intervention, it was down to 2 (range 0.8-3.3). Patients with pain intensities of 4-5 had a good chance of achieving analgesia after one session. CONCLUSIONS Fat grafting could be a new treatment modality for symptomatic fat necrosis: complete or partial suction of the necrosis and/or fat grafting around the necrosis to reduce inflammation and pain. Fat grafting proved a valuable tool, reducing pain or even achieving analgesia after breast cancer surgery presenting with a highly favorable risk-benefit ratio. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Min K, Yoon I, Kim EK. Preliminary results of alternative treatment for postmastectomy pain syndrome: stromal vascular fraction-enriched fat grafting. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2022. [DOI: 10.14730/aaps.2022.00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Postmastectomy pain syndrome (PMPS) is defined as chronic pain lasting more than 3 months after surgery. PMPS reduces the quality of life for patients and affects their daily life. Although the pathogenesis of PMPS has not been clearly elucidated, it is strongly suggestive of neuropathic pain caused by damage to the intercostobrachial nerve. While previous studies have used stromal vascular fraction (SVF)-enriched fat grafts in patients with neuralgia, few studies have used it for PMPS. Therefore, the present study evaluated the use of SVF-enriched fat, which includes adipose-derived stem cells with good differentiation capacity, in patients with PMPS to improve quality of life and reduce neuropathic pain. In three patients, the fat was mixed with concentrated SVF using a centrifuge and injected into the primary pain sites. After surgery, in all three cases, the subjective pain scale score decreased significantly over time.
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Minghao L. The process of autologous fat grafting in treating postmastectomy pain syndrome: What should we do? J Plast Reconstr Aesthet Surg 2022; 75:2001-2018. [PMID: 35304853 DOI: 10.1016/j.bjps.2022.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Li Minghao
- The Second Clinical Medical School of Guangdong Medical University, Dongguan, Guangdong, China.
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