Use of autologous fat grafting for reconstruction postmastectomy and breast conserving surgery: a systematic review protocol

Abstract

IntroductionThere is growing interest in the potential use of autologous fat grafting (AFG) for the purposes of breast reconstruction. However, concerns have been raised regarding the technique's clinical effectiveness, safety and interference with screening mammography. The objective of this systematic review was to determine the oncological, clinical, aesthetic and functional, patient reported, process and radiological outcomes for AFG.Methods and analysisAll original studies, including randomised controlled trials, cohorts studies, case–control studies, case series and case reports involving women undergoing breast reconstruction. All AFG techniques performed for the purposes of reconstruction in the postmastectomy or breast conserving surgery setting will be considered. Outcomes are defined within this protocol along; oncological, clinical, aesthetic and functional, patient reported, process and radiological domains. The search strategy has been devised to find papers about ‘fat grafting and breast reconstruction’ and is outlined within the body of this protocol. The full search strategy is outlined within the body of the protocol. The following electronic databases will be searched from 1 January 1986 to 6 June 2013: PubMed, MEDLINE, EMBASE, SCOPUS, CINAHL, PsycINFO, SciELO, The Cochrane Library, including the Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effect (DARE), the Cochrane Methodology Register, Health Technology Assessment Database, the NHS Economic Evaluation Databases and Cochrane Groups, ClinicalTrials.gov, Current Controlled Trials Database, the World Health Organisation (WHO) International Clinical Trials Registry Platform, UpToDate.com, NHS Evidence and the York Centre for Reviews and Dissemination. Grey literature searches will also be conducted as detailed in our review protocol. Eligibility assessment occurred in two stages, title and abstract screening and then full text assessment. Data were extracted and stored in a database with standardised extraction fields to facilitate easy and consistent data entry.Ethics and disseminationThis systematic review will be published in a peer-reviewed journal. It will also be presented at national and international conferences in the fields of plastic, reconstructive and aesthetic surgery and at more general surgical and methodological conferences. It will be disseminated electronically and in print. Brief reports of the review findings will be disseminated directly to the appropriate audiences of surgeons and societies through email and other modes of communication. Updates of the review will be conducted to inform and guide healthcare practice and policy.Protocol RegistrationPROSPERO—National Institute of Health Research (NIHR) Prospective Register of Systematic Reviews (CRD42013005254)

Peri-foci adipose-derived stem cells promote chemoresistance in breast cancer

“…Moreover, introduction of AdSCs to enrich the fat graft, a procedure termed cell-assisted lipotransfer, after breast mastectomy on breast cancer patients is increasing [ 35 ]. Cell-assisted lipotransfer is extensively used in plastic surgery for breast augmentation or post-mastectomy breast reconstruction [ 36 , 37 ]. The exogenously added AdSCs, obtain from healthy donors or cancer-free sites of cancer patients, play a pivotal role in improving fat graft survival rate.…”

Use of autologous fat grafting for breast reconstruction: A systematic review with meta-analysis of oncological outcomes

“…We also published our protocol a priori on the NIHR-PROSPERO database, which is freely accessible and in the British Medical Journal Open (see appendix) 73 . We have also reported our trial in line with PRISMA and AMSTAR criteria (see appendix for checklists).…”

Adipose-Derived Stem Cells in Radiotherapy Injury: A New Frontier

“…Molecular adaptations that promote graft survival include secreting hypoxia-induced growth factors such as VEGF-A or VEGF-D (see below) – both of which induce angiogenesis and lymphangiogenesis ( 107 , 108 , 113 , 135 , 141 ) – stimulating breast cancer growth and metastases ( 26 , 59 , 60 , 129 , 130 , 132 – 140 , 142 – 146 ). Krumboeck et al found that while ADSCs may not necessarily trigger transformation of quiescent tumor cells to active growth, they could promote proliferation of residual cells after cancer resection and/or adjuvant therapy ( 60 , 147 ). In contrast, proponents of fat grafting argue that in vitro models may not be representative of human tumors ( 144 , 145 ).…”