Efficacy and Outcomes of Fat Grafting Beyond the Breast: A Meta Analysis

Introduction:

            As autologous fat transfer (AFT) has become almost ubiquitous in the operating rooms of most aesthetic and reconstructive surgeons, the regenerative nature of grafted adipose tissue is fueling investigations into further applications beyond the usage in the setting of breast reconstruction. Empiric observation has demonstrated that grafted fat may ameliorate adherent scars, aide in the release of contractures, and even accelerate and improve wound healing in radiation damaged skin. As we are only beginning to understand the potential of lipotransfer, it is essential that we properly evaluate our progress. In the setting of its widespread and expanding use, the purpose of our study is to conduct a meta-analysis of “non-breast” fat grafting to elucidate the current measures of success, both from the patient and physician perspective.

Methods:

A PubMed/MEDLINE, Web of Science, and Embase search was conducted for all publications from January 1^st, 2000 to October 1^st, 2017 containing the phrase “autologous fat grafting” and related terms. The initial search yielded a total of 2255. Studies pertaining to AFT other than in the setting of breast reconstruction were individually selected to review. A review of this literature revealed significant heterogeneity of results. Of these studies, only 28 reported quantitative comparative data beyond observational or individual outcomes. No single measure of outcomes could be identified to reliably correlate the results of the various applications, so none were chosen for statistical analysis.

Results:

            A thorough review of the literature demonstrated significant inconsistency in the reporting of measurable outcomes after AFT. Of the publications which presented quantifiable data, similar applications had consistently differing measurements of the same outcome. For example, in the treatment of vocal cord paralysis, one study utilized the Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual scale, maximum phonation time (MPT), and Voice Handicap Index (VHI) whereas another described phonation time, jitter, and harmonic-to-noise ratio. In the treatment of neuropathic pain, two studies utilized the Visual Analog Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) scales, but a third just simply described the pain or lack thereof. Lastly, in the treatment of scars, one study utilized the Vancouver Scar Scale while another was evaluated using the Patient and Observer Scar Assessment Scale. While these measures are similar in nature, a statistical analysis was impractical unless the raw data could be collected. 

Conclusions:

While the aggregate data demonstrates that fat grafting has led to positive outcomes in a multitude of applications beyond breast reconstruction, this meta-analysis serves to underline the growing necessity of a validated measure of outcomes of fat grafting in these disparate settings in order to ensure we continue practicing evidence based medicine.