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 Link

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.