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. 2022 Jul;11(7):1180-1191.
doi: 10.21037/gs-22-297.

The prognosis outcomes of autologous fat transfer for breast reconstruction after breast cancer surgery: a systematic review and meta-analysis of cohort studies

Daixiong Tian #  1 , Ying Chu #  1 , Ge Zhang  2 , Dan Huang  1 , Jialin Huang  1 , Jin Zeng  1
Affiliations

The prognosis outcomes of autologous fat transfer for breast reconstruction after breast cancer surgery: a systematic review and meta-analysis of cohort studies

Daixiong Tian et al. Gland Surg. 2022 Jul.

Abstract

Background: Autologous fat transfer (AFT) is a minimally invasive technique that employs a patient's own fat to correct disfiguring sequelae for breast reconstruction in postoperative breast cancer patients. However, the results of studies on this topic were controversial. In order to explore the effect of AFT on breast reconstruction after breast cancer surgery, we included cohort studies and conducted a meta-analysis.

Methods: A literature search was conducted using PubMed, Embase, Cochrane Library, and Web of Science databases for relevant studies published up to September 14, 2020. We identified the eligible studies based on the PICOS principles, populations (patients diagnosed with breast cancer), interventions (patients undergoing AFT after breast cancer surgery), controls (patients who did not receive AFT after breast cancer surgery), outcomes [local recurrence (LR) rate, regional recurrence (RRR) rate, locoregional recurrence (LRR) rate, distant metastasis rate, systemic recurrence (SR) rate, and total death rate], study design (cohort studies). The I2 statistic was conducted to estimate heterogeneity. Relative risks (RRs) with 95% confidence intervals (CIs) were presented to evaluate whether AFT compromises oncological safety in breast reconstruction. Funnel plots and Egger's test were adopted to assess publication bias. Quality assessment for the included studies using the Newcastle-Ottawa Scale (NOS).

Results: Twenty-two cohort studies involving 9,971 postoperative patients with breast cancer were identified, with 3,622 receiving AFT being the experimental group, and 6,349 not receiving AFT in the control group. The overall quality of the included studies was rated as high. No significant differences in the rate of LR (RR: 0.916, 95% CI: 0.704-1.192), RRR (RR: 1.175, 95% CI: 0.773-1.787), LRR (RR: 0.788, 95% CI: 0.617-1.006), distant metastasis (RR: 1.133, 95% CI: 0.906-1.417), and total deaths (RR: 0.753, 95% CI: 0.539-1.051) were observed between the experimental group and control group (P>0.05). However, the AFT group had a lower rate of SR (RR: 0.671, 95% CI: 0.491-0.915, P=0.012).

Conclusions: The AFT group did not increase the rate of LR, RRR, LRR, distant metastasis, and total deaths in postoperative patients, which may indicate that AFT can be performed safely in breast reconstruction after excision of breast tumor.

Keywords: Autologous fat transfer (AFT); after breast cancer operation; breast reconstruction; meta-analysis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-22-297/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of literature search.
Figure 2
Figure 2
Forest plot of local recurrence rate. P value represents the P value of I2. RR, relative risk; CI, confidence intervals.
Figure 3
Figure 3
Forest plot of regional recurrence rate. P value represents the P value of I2. RR, relative risk; CI, confidence intervals.
Figure 4
Figure 4
Forest plot of locoregional recurrence rate. P value represents the P value of I2. RR, relative risk; CI, confidence intervals.
Figure 5
Figure 5
Forest plot of systemic recurrence rate. P value represents the P value of I2. RR, relative risk; CI, confidence intervals.
Figure 6
Figure 6
Forest plot of distant metastasis rate. P value represents the P value of I2. RR, relative risk; CI, confidence intervals.
Figure 7
Figure 7
Forest plot of total death rate. P value represents the P value of I2. RR, relative risk; CI, confidence intervals.
See this image and copyright information in PMC

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