Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience

Fabio Caviggioli, Luca Maione, Francesco Klinger, Andrea Lisa, Marco Klinger, Fabio Caviggioli, Luca Maione, Francesco Klinger, Andrea Lisa, Marco Klinger

Abstract

Introduction. Pain syndromes affect women after conservative and radical breast oncological procedures. Radiation therapy influences their development. We report autologous fat grafting therapeutical role in treating chronic pain in irradiated patients. Materials and Methods. From February 2006 to November 2014, we collect a total of 209 patients who meet the definition of "Postmastectomy Pain Syndrome" (PMPS) and had undergone mastectomy with axillary dissection (113 patients) or quadrantectomy (96 patients). Both procedures were followed by radiotherapy. We performed fat grafting following Coleman's procedure. Mean amount of adipose tissue injected was 52 cc (±8.9 cc) per breast. Seventy-eight in 209 patients were not treated surgically and were considered as control group. Data were gathered through preoperative and postoperative VAS questionnaires; analgesic drug intake was recorded. Results. The follow-up was at 12 months (range 11.7-13.5 months). In 120 treated patients we detected pain decrease (mean ± SD point reduction, 3.19 ± 2.86). Forty-eight in 59 patients stopped their analgesic drug therapy. Controls reported a mean ± SD decrease of pain of 1.14 ± 2.72. Results showed that pain decreased significantly in patients treated (p < 0.005, Wilcoxon rank-sum test). Conclusion. Our 8-year experience confirms fat grafting effectiveness in decreasing neuropathic pain.

References

    1. Andersen K. G., Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. The Journal of Pain. 2011;12(7):725–746. doi: 10.1016/j.jpain.2010.12.005.
    1. International Association for the Study of Pain: Task Force on Taxonomy. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definition of Pain Terms. 2nd. Seattle, Wash, USA: IASP Press; 1994.
    1. Andersen K. G., Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. Journal of Pain. 2011;12(7):725–746. doi: 10.1016/j.jpain.2010.12.005.
    1. Steegers M. A., Wolters B., Evers A. W., Strobbe L., Wilder-Smith O. H. Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breastcancer surgery. Journal of Pain. 2008;9(9):813–822. doi: 10.1016/j.jpain.2008.04.001.
    1. Andersen K. G., Jensen M. B., Kehlet H., Gärtner R., Eckhoff L., Kroman N. Persistent pain, sensory disturbances and functional impairment after adjuvant chemotherapy for breast cancer: cyclophosphamide, epirubicin and fluorouracil compared with docetaxel + epirubicin and cyclophosphamide. Acta Oncologica. 2012;51(8):1036–1044. doi: 10.3109/0284186X.2012.692884.
    1. Schreiber K. L., Martel M. O., Shnol H., et al. Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain. Pain. 2013;154(5):660–668. doi: 10.1016/j.pain.2012.11.015.
    1. Tasmuth T., Blomqvist C., Kalso E. Chronic post-treatment symptoms in patients with breast cancer operated in different surgical units. European Journal of Surgical Oncology. 1999;25(1):38–43. doi: 10.1053/ejso.1998.0597.
    1. Caviggioli F., Maione L., Forcellini D., Klinger F., Klinger M. Autologous fat graft in postmastectomy pain syndrome. Plastic and Reconstructive Surgery. 2011;128(2):349–352. doi: 10.1097/prs.0b013e31821e70e7.
    1. Maione L., Vinci V., Caviggioli F., et al. Autologous fat graft in postmastectomy pain syndrome following breast conservative surgery and radiotherapy. Aesthetic Plastic Surgery. 2014;38(3):528–532. doi: 10.1007/s00266-014-0311-9.
    1. Wood K. M. Intercostobrachial nerve entrapment syndrome. Southern Medical Journal. 1978;71(6):662–663. doi: 10.1097/00007611-197806000-00016.
    1. Kwekkeboom K. Postmastectomy pain syndromes. Cancer Nursing. 1996;19(1):37–43. doi: 10.1097/00002820-199602000-00005.
    1. Cantarero-Villanueva I., Fernández-Lao C., Fernández-De-Las-Peñas C., Díaz-Rodríguez L., Sanchez-Cantalejo E., Arroyo-Morales M. Associations among musculoskeletal impairments, depression, body image and fatigue in breast cancer survivors within the first year after treatment. European Journal of Cancer Care. 2011;20(5):632–639. doi: 10.1111/j.1365-2354.2011.01245.x.
    1. Blunt C., Schmiedel A. Some cases of severe post-mastectomy pain syndrome may be caused by an axillary haematoma. Pain. 2004;108(3):294–296. doi: 10.1016/j.pain.2003.12.011.
    1. Hamner J. B., Fleming M. D. Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer. Annals of Surgical Oncology. 2007;14(6):1904–1908. doi: 10.1245/s10434-006-9332-1.
    1. McQuay H. J., Tramèr M., Nye B. A., Carroll D., Wiffen P. J., Moore R. A. A systematic review of antidepressants in neuropathic pain. Pain. 1996;68(2-3):217–227. doi: 10.1016/S0304-3959(96)03140-5.
    1. Rigotti G., Marchi A., Galiè M., et al. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plastic and Reconstructive Surgery. 2007;119(5):1409–1424. doi: 10.1097/01.prs.0000256047.47909.71.
    1. Klinger M., Marazzi M., Vigo D., Torre M. Fat injection for cases of severe burn outcomes: a new perspective of scar remodeling and reduction. Aesthetic Plastic Surgery. 2008;32(3):465–469. doi: 10.1007/s00266-008-9122-1.
    1. Klinger M., Lisa A., Klinger F., et al. Regenerative approach to scars, ulcers and related problems with fat grafting. Clinics in Plastic Surgery. 2015;42(3):345–352. doi: 10.1016/j.cps.2015.03.008.
    1. Klinger M., Caviggioli F., Klinger F., Pagliari A. V., Villani F., Bandi V. Scar remodeling following burn injuries. In: Coleman S. R., Mazzola R. F., editors. Fat Injection: From Filling to Regeneration. St. Louis, Mo, USA: Quality Medical Publishing; 2009.
    1. Maione L., Memeo A., Pedretti L., et al. Autologous fat graft as treatment of post short stature surgical correction scars. Injury. 2014;45(6):S126–S132. doi: 10.1016/j.injury.2014.10.036.
    1. Rowland J. W., Hawryluk G. W. J., Kwon B., Fehlings M. G. Current status of acute spinal cord injury pathophysiology and emerging therapies: promise on the horizon. Neurosurgical Focus. 2008;25(5, article E2) doi: 10.3171/foc.2008.25.11.e2.
    1. Klinger M., Villani F., Klinger F., Gaetani P., Rodriguez Y Baena R., Levi D. Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches. Plastic and Reconstructive Surgery. 2009;124(5):1727–1728. doi: 10.1097/prs.0b013e3181b98d6f.
    1. Lisa A., Maione L., Vinci V., Caviggioli F., Klinger M. E. A systematic review of peripheral nerve interventional treatments for chronic headaches. Annals of Plastic Surgery. 2015;74(4, article 515) doi: 10.1097/sap.0000000000000308.
    1. Geissler P. J., Davis K., Roostaeian J., Unger J., Huang J., Rohrich R. J. Improving fat transfer viability: the role of aging, body mass index, and harvest site. Plastic and Reconstructive Surgery. 2014;134(2):227–232. doi: 10.1097/prs.0000000000000398.

Source: PubMed

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