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

Bhagvat Maheta; Pooja S Yesantharao; Kometh Thawanyarat; Maheen F Akhter; Mallory Rowley; Rahim S Nazerali

doi:10.1016/j.bjps.2023.09.026

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

J Plast Reconstr Aesthet Surg. 2023 Nov:86:273-279. doi: 10.1016/j.bjps.2023.09.026. Epub 2023 Sep 14.

Authors

Bhagvat Maheta¹, Pooja S Yesantharao², Kometh Thawanyarat³, Maheen F Akhter⁴, Mallory Rowley⁵, Rahim S Nazerali⁶

Affiliations

¹ California Northstate University College of Medicine, Elk Grove, CA, USA.
² Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA.
³ Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, GA, USA.
⁴ Central Michigan University College of Medicine, Saginaw, MI, USA.
⁵ State University of New York, Upstate Medical University, Syracuse, NY, USA.
⁶ Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: rahimn@stanford.edu.

PMID: 37797375
DOI: 10.1016/j.bjps.2023.09.026

Abstract

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.

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

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adipose Tissue / transplantation
Breast Neoplasms* / surgery
Female
Humans
Mammaplasty* / methods
Mastectomy / methods
Quality of Life
Treatment Outcome