Herly Mikkel, Ørholt Mathias, Larsen Andreas, Pipper Christian B, Bredgaard Rikke, Gramkow Christina S, Katz Adam J, Drzewiecki Krzysztof T, Vester-Glowinski Peter V
Department of Plastic Surgery, Breast Surgery and Burns, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Plastic Surgery, Breast Surgery and Burns, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
J Plast Reconstr Aesthet Surg. 2018 Dec;71(12):1740-1750. doi: 10.1016/j.bjps.2018.08.024. Epub 2018 Sep 4.
Breast reconstruction with fat grafting is a new alternative to prosthetic implants and flaps for women with breast cancer. In this study, we investigate the efficacy of fat grafting for breast reconstruction in a meta-analysis.
The study followed the PRISMA and MOOSE guidelines for systematic reviews and meta-analyses. Studies were included if the patients underwent complete breast reconstruction with fat grafting as the only treatment modality. The number of fat grafting treatments needed to complete a breast reconstruction was modeled in a meta-analysis for five treatment categories: modified radical mastectomy, skin-sparing mastectomy, and breast-conserving surgery; the two mastectomy groups were subdivided into nonirradiated and irradiated.
Twenty-one studies were included in the meta-analysis. The studies comprised 1011 breast reconstructions in 834 patients. The estimated numbers of treatments to complete a reconstruction were 2.84-4.66 in the mastectomy groups and 1.72 in the breast-conserving surgery group. The number of fat grafting sessions needed to complete a breast reconstruction was significantly higher for the irradiated patients than for the nonirradiated patients (p < 0.05). There was no significant difference in the number of fat grafting sessions needed to complete a breast reconstruction after a modified radical mastectomy versus a skin-sparing mastectomy.
This study provides an evidence-based foundation for several practical issues related to breast reconstruction with fat grafting. The analysis showed that radiotherapy is the most important factor associated with the number of treatment sessions needed to complete a breast reconstruction and with the rate of complications.
对于乳腺癌女性患者，脂肪移植乳房重建是假体植入和皮瓣移植的一种新的替代方法。在本研究中，我们通过荟萃分析来探究脂肪移植用于乳房重建的疗效。
本研究遵循系统评价和荟萃分析的PRISMA和MOOSE指南。纳入的研究要求患者接受以脂肪移植作为唯一治疗方式的全乳房重建。在一项荟萃分析中，针对以下五种治疗类别模拟了完成乳房重建所需的脂肪移植治疗次数：改良根治性乳房切除术、保留皮肤的乳房切除术和保乳手术；两个乳房切除术组又细分为未接受放疗和接受放疗的亚组。
荟萃分析纳入了21项研究。这些研究包括834例患者的1011例乳房重建。在乳房切除术组中，完成一次重建所需的治疗次数估计为2.84 - 4.66次，在保乳手术组中为1.72次。接受放疗的患者完成乳房重建所需的脂肪移植次数显著高于未接受放疗的患者（p < 0.05）。改良根治性乳房切除术后与保留皮肤的乳房切除术后完成乳房重建所需的脂肪移植次数无显著差异。
本研究为与脂肪移植乳房重建相关的几个实际问题提供了循证基础。分析表明，放疗是与完成乳房重建所需的治疗次数以及并发症发生率相关的最重要因素。
