Oncological safety of autologous fat grafting for breast reconstruction after mastectomy: a meta-analysis

Abstract

Objective To investigate the oncological safety of autologous fat grafting for breast reconstruction after mastectomy in breast cancer patients. Methods The PubMed, Embase, Cochrane, CNKI, Wanfang and VIP databases were searched for all published relevant cohort studies up to May 2018. According to the Newcastle Ottawa Scale (NOS), the literature screening, data extraction and systematic evaluation were performed by two reviewers independently. A meta-analysis was performed using the RevMan 5.3 software, with odds ratio (OR) and 95% confidence interval (CI) as the effect size. Results Thirteen studies were included, with a sample size of 8 466 patients including 1 963 patients in autologous fat grafting group (AFG group) and 6 503 patients in non-fat grafting group (NFG group). The NOS scores were 6 to 9, indicating high methodological quality. The meta-analysis showed that 455 patients (7.0%, 455/6 503) in NFG group had recurrence, while 88 patients (4.5%, 88/1 963) in AFG group had recurrence, indicating that the recurrence rate of AFG group was significantly lower than that of NFG group (OR=0.73, 95%CI: 0.57-0.95, P=0.02). Fat grafting had no significant effect on the local recurrence rate, regional recurrence rate and distant recurrence rate (OR=1.06, 95%CI: 0.60-1.88, P=0.84; OR=0.89, 95%CI: 0.32-2.48, P=0.83; OR=0.36, 95%CI: 0.10-1.28, P=0.11). Subgroup analysis showed that fat grafting had no significant effect on the recurrence rate of breast cancer in patients with carcinoma in situ or invasive carcinoma (OR=1.16, 95%CI: 0.05-26.91, P=0.93; OR=0.68, 95%CI: 0.40-1.16, P=0.16). The fat grafting still had no significant effect on the recurrence rate of breast cancer in the patients undergoing breast-conserving surgery or total mastectomy (OR=0.36, 95%CI: 0.08-1.66, P=0.19; OR=0.64, 95%CI: 0.33-1.26, P=0.19). Conclusion Based on our meta-analysis of the cohort studies from January 1965 to May 2018, autologous fat grafting is feasible, with low risk of recurrence. Key words: Meta-analysis; Breast neoplasms; Mammaplasty; Autologous fat grafting; Oncological safety