Fat Graft

Fat Graft

PEP Topic 
Chronic Pain
Description 

Fat tissue grafting has been done by injecting fat tissue that is obtained via liposuction. This procedure was examined in women with severe scare retraction and postmastectomy pain for its effect on pain.

Effectiveness Not Established

Research Evidence Summaries

Caviggioli, F., Maione, L., Forcellini, D., Klinger, F., & Klinger, M. (2011). Autologous fat graft in postmastectomy pain syndrome. Plastic and Reconstructive Surgery, 128, 349–352.

doi: 10.1097/PRS.0b013e31821e70e7
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Study Purpose:

To assess the clinical effectiveness of lipoaspirate graft in the treatment of postmastectomy pain syndrome

Intervention Characteristics/Basic Study Process:

At baseline (prior to autologous fat grafting) and after treatment, pain was measured using a visual analog scale, and analgesic and drug intake were recorded. A nontreatment control group completed the same measures. At one year, measures were repeated in both groups.

Sample Characteristics:

  • The study reported on 113 patients with severe scar retraction and postmastectomy pain syndrome related to breast cancer (treatment group = 72, control group = 41). Sixty-three patients in the treatment group and 35 patients in the control were analyzed.
  • Patient age was not reported.
  • The sample was assumed to be 100% female due to breast cancer population, but this was not stated.

Setting:

  • Single site
  • Milan, Italy

Phase of Care and Clinical Applications:

  • Patients were undergoing the active treatment phase of care.
  • The study has clinical applicability for late effects and survivorship.

Study Design:

The study was a prospective, longitudinal intervention with experimental and control groups.

Measurement Instruments/Methods:

  • Visual analog scale for pain (0–10) at baseline and one year     
  • Analgesic use recorded at baseline and one year

Results:

In the treatment group, there was a decrease in pain (p < 0.0005). The authors noted that 28 of 34 patients stopped their analgesic therapy at 13 months.

Limitations:

  • The study has a small sample, with less than 100 participants.
  • The study lacks a randomized control group.
  • Information about demographics is missing, making baseline characterization of the groups difficult to ascertain.

Nursing Implications:

More research is needed to determine if autologous fat grafts will benefit women with postmastectomy pain, but this may be a promising area of study.

Maione, L., Vinci, V., Caviggioli, F., Klinger, F., Banzatti, B., Catania, B., . . . Klinger, M. (2014). Autologous fat graft in postmastectomy pain syndrome following breast conservative surgery and radiotherapy. Aesthetic Plastic Surgery, 38, 528–532. 

doi:10.1007/s00266-014-0311-9
Print

Study Purpose:

To evaluate the effectiveness of autologous fat grafting to control pain in patients with persistent postmastectomy pain syndrome (PMPS)

Intervention Characteristics/Basic Study Process:

Patients who received lumpectomies and radiation therapy and had severe scar retraction, radiodystrophy, and chronic pain met the definition of PMPS and were considered for the study. Patients who had fat grafting underwent liposuction of the subumbilical area, and the obtained fat was processed and purified. The fat was then injected into the scar area. Study data were obtained at baseline and at one year after the procedure. Patients who had the fat graft procedure were compared to patients who did not receive the procedure.

Sample Characteristics:

  • N = 92  
  • MEAN AGE = 52.5 years (range = 33–68 years)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Patients with breast cancer and PMPS; none had chemotherapy, local recurrence, or previous breast surgery other than the initial lumpectomy

Setting:

  • SITE: Single site  
  • SETTING TYPE: Outpatient    
  • LOCATION: Italy

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment

Study Design:

Prospective trial

Measurement Instruments/Methods:

  • Visual Analog Scale (VAS) for pain

Results:

Among those who had the fat graft procedure, there was a mean reduction of 3.1 points for pain compared to a mean reduction of 0.9 points in the comparison group (p ≤ 0.005).

Conclusions:

Autologous fat grafting may have reduced PMPS.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement/methods not well described
  • Other limitations/explanation: It was not clear if the VAS measurement was of worst pain, average pain, etc., or over what time period it was considered.

Nursing Implications:

Persistent pain as a consequence of surgical treatment for breast cancer is a clinical problem for which the general treatment is pain medication. Nurses need to be aware of this syndrome and educate patients about alternative approaches that may be available for management. Additional well-designed research regarding the efficacy of fat grafting for this population is needed.

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