ABSTRACT
BACKGROUND: Exclusive fat grafting is an alternative method to implant- or flap- based reconstruction techniques following mastectomies or breast conservation therapies. Its efficacy has been explored before but new data has come to light, resulting in previous results becoming outdated. Concerns have also been raised about the oncological safety of this procedure which must be evaluated alongside the efficacy to gain a comprehensive understanding of the merits of this alternative technique. METHODS: We queried the PubMed electronic database from its inception until August 2023 for studies evaluating the efficacy and oncological safety of exclusive fat grafting breast reconstruction following cancer-related mastectomy or breast conservation therapy. Results of the analysis were pooled and presented as means or valid proportions. Results of the analysis were pooled using a random-effects model and presented with 95% confidence intervals (95% CIs) where appropriate. RESULTS: 41 studies were included in our analysis. Pooled results show that on average, 1.7 sessions of exclusive fat grafting were required to complete reconstruction in Breast Conservation Therapy (BCT) patients, with an average volume of 114.2 ml being injected. For mastectomy patients with irradiated breasts, 4.7 sessions were needed on average with 556.8 ml being required to complete reconstruction, compared to their non-irradiated Counterparts requiring only 2.6 sessions and 207.2 ml to complete reconstruction. Oncological recurrence events were found in 29/583 non-irradiated mastectomy patients (p = 0.014) and in 41/517 BCT patients (p = 0.301) CONCLUSION: Exclusive fat grafting is an oncologically safe and reasonably efficacious alternative to more common methods of breast reconstruction. More data is needed to fully characterize the oncological safety of this procedure in irradiated and non-irradiated mastectomy patients. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
ABSTRACT
INTRODUCTION: Sickle cell disease (SCD) is among the common prevalent diseases in Saudi Arabia. It is associated with several complications that sometimes necessitate surgical procedures. Those patients can also have a lower quality of life (QoL) due to several reasons. Our aim in this study is to highlight the association between sociodemographic data, clinical data, and SCD-related surgeries in patients with their QoL. METHODS: A cross-sectional study was performed using a validated Arabic version of the World Health Organization QoL-BREF (WHOQOL-BREF) questionnaire distributed in electronic form. Male and female Arabic speakers (18+ years old) of Saudi origin were included in this study; those who did not meet these criteria were excluded. RESULTS: We distributed 309 questionnaires to the targeted subjects; however, only 204 met our inclusion criteria. Our findings revealed 135 female respondents and 69 male respondents. Interestingly, splenectomy was not significantly associated with a difference in all aspects of QoL in SCD patients. However, the data showed significantly lower respective mean scores for physical health (p=0.002 & p=0.022) and overall QoL (p=0.024 & p=0.042) for those who underwent cholecystectomy and hip arthroplasty. In contrast, shoulder arthroplasty appeared to be associated with significantly lower mean scores for physical health (T=-2.597; p=0.010) and the environmental aspect of QoL (T=-2.016; p=0.045). CONCLUSION: Cholecystectomy, hip arthroplasty, and shoulder arthroplasty were significantly associated with lower QoL in SCD patients.
