Autologous fat graft in postmastectomy pain syndrome following breast conservative surgery and radiotherapy.
BACKGROUND
Breast cancer is the most common cancer in women worldwide, affecting one in eight women. Breast-conserving surgery (BCS) has become a well-established alternative to mastectomy in the treatment of breast cancer, providing a less invasive treatment. Just as life expectancy after breast cancer has improved, so has morbidity increased. One of the most relevant and debilitating consequences of oncological breast surgery is postmastectomy pain syndrome (PMPS). Our results published in 2011 on the treatment of PMPS in patients who had undergone mastectomy and radiotherapy and our experience in scar treatment with fat grafts were the theoretical bases for this prospective study.


METHODS
From April 2011 to April 2012 a total of 96 patients, who had undergone lumpectomy and radiation therapy, with the diagnosis of PMPS were considered for fat grafts. We performed autologous fat grafting in 59 patients (study group), whereas 37 patients did not receive any further surgical procedure (control group). Pain assessment was performed using the visual analog scale (VAS) before and after treatment in the treated group and in the control group at the first visit and the control visit, with a mean follow-up of 10 months. Results were analyzed using the Wilcoxon rank sum test.


RESULTS
Four patients were lost to follow-up (two patients in the control group and two patients in the treated group). A significant VAS pain decrease was detected in patients treated with autologous fat grafting (3.1 point reduction, p ≤ 0.005).


CONCLUSIONS
Because of the safety, efficacy, and optimal tolerability of the procedure, we believe that fat grafting can be considered useful in treating PMPS in patients who have undergone BCS and radiotherapy.


METHODS
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Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Luca
L
Maione
Valeriano
V
Vinci
Fabio
F
Caviggioli
Francesco
F
Klinger
Barbara
B
Banzatti
Barbara
B
Catania
Andrea
A
Lisa
Marco
M
Klinger
D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D064592:Autografts; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D010147:Pain Measurement; D010149:Postoperative Pain / Q000601:surgery*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D013577:Syndrome