Bennett Katelyn G, Qi Ji, Kim Hyungjin M, Hamill Jennifer B, Wilkins Edwin G, Mehrara Babak J, Kozlow Jeffrey H
Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor.
Center for Statistical Consultation and Research, University of Michigan, Ann Arbor.
JAMA Surg. 2017 Oct 1;152(10):944-950. doi: 10.1001/jamasurg.2017.1716.
Fat grafting has proven to be a useful adjunct to breast reconstruction for the treatment of contour irregularities and volume deficits, but the proposed US Food and Drug Administration regulations may severely limit the ability of plastic surgeons to continue its use in this clinical context.
To determine whether fat grafting is associated with patient-reported outcomes (PROs) in patients undergoing breast reconstruction.
DESIGN, SETTING, AND PARTICIPANTS: A longitudinal, multicenter, prospective cohort study was conducted between February 1, 2012, and July 31, 2016, at the 11 sites associated with the Mastectomy Reconstruction Outcomes Consortium Study. Eligible patients included women 18 years or older presenting for breast reconstruction after mastectomy with 2 years or more of follow-up. All primary procedure types (implant based and flap based) were eligible. Patients were excluded if they had not completed breast mound reconstruction by 1 year after starting reconstruction.
Fat grafting as an adjunct to breast mound reconstruction.
Primary end points were patient-reported outcome measures as assessed by the validated BREAST-Q survey, with higher scores on a 0- to 100-point scale indicating better health-related quality of life. Survey subscales included breast satisfaction, as well as psychosocial, physical, and sexual well-being. Patient-reported outcomes were compared between those who received and did not receive fat grafting.
A total of 2048 women were included (mean [SD] age, 49.4 [10] years), with 165 (8.1%) undergoing fat grafting between years 1 and 2. One year postoperatively, patients who later underwent fat grafting reported significantly lower breast satisfaction (adjusted mean difference [AMD], -4.74; 95% CI, -8.21 to -1.28; P = .008), psychosocial well-being (AMD, -3.87; 95% CI, -7.33 to -0.40; P = .03), and sexual well-being (AMD, -5.59; 95% CI, -9.70 to -1.47; P = .008), compared with those who did not receive subsequent fat grafting. Following the procedure, the fat-grafted cohort reported similar breast satisfaction (AMD, -0.68; 95% CI, -4.42 to 3.06; P = .72), psychosocial well-being (AMD, -0.59; 95% CI, -3.92 to 2.74; P = .73), and sexual well-being (AMD, -2.94; 95% CI, -7.01 to 1.12; P = .15) 2 years postoperatively.
Fat grafting may improve breast satisfaction, psychosocial well-being, and sexual well-being in patients undergoing breast reconstruction.
脂肪移植已被证明是乳房重建的一种有用辅助手段，可用于治疗外形不规则和体积不足，但美国食品药品监督管理局提议的法规可能会严重限制整形外科医生在这种临床情况下继续使用它的能力。
确定脂肪移植与接受乳房重建患者的患者报告结局（PROs）是否相关。
设计、地点和参与者：2012年2月1日至2016年7月31日，在与乳房切除术重建结局联盟研究相关的11个地点进行了一项纵向、多中心、前瞻性队列研究。符合条件的患者包括18岁及以上在乳房切除术后进行乳房重建且有2年或更长时间随访的女性。所有主要手术类型（基于植入物和基于皮瓣）均符合条件。如果患者在开始重建后1年内未完成乳房隆起重建，则被排除。
脂肪移植作为乳房隆起重建的辅助手段。
主要终点是通过经过验证的BREAST-Q调查评估的患者报告结局指标，在0至100分的量表上得分越高表明与健康相关的生活质量越好。调查子量表包括乳房满意度以及心理社会、身体和性健康状况。比较接受和未接受脂肪移植患者的患者报告结局。
共纳入2048名女性（平均[标准差]年龄，49.4[10]岁），其中165名（8.1%）在第1年至第2年期间接受了脂肪移植。术后1年，后来接受脂肪移植的患者报告的乳房满意度（调整后平均差异[AMD]，-4.74；95%置信区间，-8.21至-1.28；P = 0.008）、心理社会健康状况（AMD，-3.87；95%置信区间，-7.33至-0.40；P = 0.03）和性健康状况（AMD，-5.59；95%置信区间，-9.70至-1.47；P = 0.008），与未接受后续脂肪移植的患者相比显著更低。手术后，脂肪移植队列在术后2年报告的乳房满意度（AMD，-0.68；95%置信区间，-4.42至3.06；P = 0.72）、心理社会健康状况（AMD，-0.59；95%置信区间，-3.92至2.74；P = 0.73）和性健康状况（AMD，-2.94；95%置信区间，-7.01至1.12；P = 0.15）相似。
脂肪移植可能会改善接受乳房重建患者的乳房满意度、心理社会健康状况和性健康状况。
