Touching up post-mastectomy breast reconstructions with autologous fat grafts made women happier with the results, improving their satisfaction, psychosocial well-being, and sexual well-being, a longitudinal prospective cohort study found. Prior to undergoing fat grafting, women who chose to have the procedure reported significantly lower breast satisfaction (adjusted mean difference −4.74; 95% CI −8.21 to −1.28; P=0.008), psychosocial well-being (AMD −3.87; 95% CI −7.33 to −0.40; P=0.03), and sexual well-being (AMD −5.59; 95% CI −9.70 to −1.47; P=0.008), compared with women who felt they didn't need fat grafting, reported researchers led by Katelyn Bennett, MD, of the University of Michigan Health System in Ann Arbor. After the grafting, these women had "caught up" to the others, reporting similar breast satisfaction (AMD −0.68; 95% CI −4.42 to 3.06; P=0.72), psychosocial well-being (AMD −0.59; 95% CI −3.92 to 2.74; P=0.73), and sexual well-being (AMD −2.94; 95% CI −7.01 to 1.12; P=0.15), Bennett's group said online in JAMA Surgery. "During the past 2 decades, fat grafting has revolutionized breast reconstruction, enabling plastic surgeons to significantly improve aesthetic outcomes. Contour irregularities and volume deficits in both autologous and implant-based reconstructions can both be addressed with autologous fat transfer," the researchers wrote. Initial concerns about the possibilities of fat necrosis and an increased risk for breast cancer recurrence were not substantiated by studies, and guidelines from the American Society of Plastic Surgeons now endorse fat grafting, Bennett and colleagues noted. However, concerns still remain, and the FDA recently proposed new guidance for autologous fat grafting, they said. "Thus, well-designed research assessing the efficacy of fat grafting is essential not only for high-quality patient care, but also to meet growing regulatory concerns over these procedures," Bennett and colleagues wrote. "Despite the widespread assumption that patients are pleased with the results of fat grafting, there have been few studies assessing the effects of these techniques on patient reported outcomes." In an accompanying editorial, Scott Hollenbeck, MD, and Shelley Hwang, MD, both of Duke University in Durham, N.C., said, "The study is notable, as it is the first in the literature to provide patient-reported outcomes regarding fat grafting in the setting of a prospective trial... These data support that fat grafting can be a useful adjunct in the reconstructive process and may help those patients struggling with their overall reconstruction." The Mastectomy Reconstruction Outcomes Consortium Study included 2,048 women enrolled from 2012 to 2016. Their mean age was 49. Most (89.5%) underwent mastectomy for cancer treatment. More than half (60%) received implant-based reconstruction, 38% received autologous procedures, and the rest underwent mixed procedures. All participants had completed breast mound reconstruction by the first year of the study. Between the first and second year, 165 women chose to have fat grafting. Patient reported outcomes were assessed at years one and two with the BREAST-Q survey, a validated survey with scores ranging from 0 to 100. Higher scores indicated better satisfaction or health-related quality of life. The survey assessed patient satisfaction with the reconstructed breast as well as psychosocial, physical, and sexual well-being. Rates of cancer recurrence did not differ between groups in the study (1.8% in the grafted patients versus 2.0% for those ungrafted), confirming the previous studies that found no significant risk, Hollenbeck and Hwang noted. "We hope that this study will contribute to the ongoing discussion with payers and regulators over the safety and effectiveness of these procedures," the study authors wrote. An important limitation of the study was that significantly more women who chose fat grafting also chose to have other revision procedures, compared to women who did not elect to have fat grafting (75% versus 17%; P<0.001). "Bennett et al. account for this in their analysis," the editorialists observed. "[H]owever, it is difficult to ascertain how much of the improvement in breast satisfaction can be attributed to fat grafting itself rather than to the other revisions," they said. Source
