Studies on outcome and quality of life after autologous fat grafting and breast reconstruction

Department of Plastic and Breast Surgery, Alexander Juhl Andersen

This PhD thesis investigates persistent pain after breast cancer treatment (1 study), and outcome and quality of life after autologous fat grafting and breast reconstruction (3 studies).

In the first study, the prevalence of persistent pain was investigated in 305 patients having undergone mastectomy as treatment for breast cancer at our institution from 2009 to 2013. Furthermore, the type of pain (neuropathic or nociceptive) and variables associated with persistent pain was examined. With 38% of patients reporting pain in the mastectomy area at a mean follow-up after 3 years, the prevalence of persistent pain was comparable to previous studies. Of the patients with persistent pain, only 13% had a clear neuropathic pain component, indicating that the aetiology of the pain is likely to be multifactorial. Only Body Mass Index ≥ 30 kg/m² was independently associated with reporting persistent pain.

The second study is the first randomized controlled trial investigating the possible analgesic effect of autologous fat grafting. In this study, 15 patients with persistent pain after mastectomy were randomized to either a control group or to undergo autologous fat grafting to the pain afflicted area around their missing breast. At baseline, three and six months postoperatively, patients were examined with regards to pain intensity, pain quality and scar quality. A statistically significant analgesic effect of autologous fat grafting on persistent pain after breast cancer treatment was found. Furthermore, the results indicated a beneficial scar remodeling effect of autologous fat grafting. Although the results from the study were highly statistically significant, the study did not reach the a priori calculated sample size; thus, results should be interpreted conservatively.

In the third study, a population of 42 women with breast defects due to breast conserving surgery underwent radiologic breast imaging before and after reconstruction with autologous fat grafting. Additionally, the outcome of the procedure was investigated using patient-reported outcome measures and observer evaluation. The results indicate that even though autologous fat grafting to the breast causes radiological breast imaging changes at a mean follow-up of 9 months, the changes are discernable from radiological signs of breast cancer recurrence and cause an acceptable number of additional examinations and biopsies. Moreover, statistically significant improvements were found in body image, breast aesthetic appearance and scar quality.

In the fourth study, 196 patients scheduled to undergo breast reconstruction completed validated scales for personality traits, body image and quality of life, prior to and six-months after breast reconstruction. In the study, high neuroticism was found to be a significant predictor for achieving a lower quality of life and a poorer body image at six-month follow-up. Furthermore, baseline scores of the investigated variables were highly positively correlated with the achieved outcome.

In conclusion, the results from the thesis provide further evidence for the rehabilitation potential of plastic and reconstructive surgery after breast cancer treatment. Moreover, novel insight into factors that may affect the achieved patient-reported outcome after breast reconstruction have been described.