Priority 10 from the Post Mastectomy Breast Reconstruction PSP

UNCERTAINTY:What is the evidence and safety behind fat grafting for breast reconstruction? (JLA PSP Priority 10)
Overall ranking	10
JLA question ID	0109/10
Explanatory note	Fat grafting to the reconstructed breast is a relatively novel, but commonly performed procedure in the reconstructed breast. Long-term evidence on the viability of the grafted fat is lacking. Also the safety behind fat grafting to the reconstructed breast is poorly understood. Better research is need to understand the biology of the newly grafted fat in the reconstructed breast short- and long-term, as well as the safety implications of fat grafting into the reconstructed breast.
Evidence	Autologous skin grafting for breast reconstruction: what is the safety concerns of for autologous skin grafting for women that have operable primary breast cancer Breast reconstruction using lipomodelling after breast cancer treatment. Evidence-based recommendations on breast reconstruction using lipomodelling after breast cancer treatment. Laparoscopic mobilisation of the greater omentum for breast reconstruction. Evidence-based recommendations on laparoscopic mobilisation of the greater omentum (keyhole surgery) for breast Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer. Alberta Health Services - Cancer Care Breast cancer reconstruction surgery (immediate and delayed) across Ontario: patient indications and appropriate surgical options. Cancer Care Ontario's Program in Evidence-based Care
Health Research Classification System category	Cancer

Extra information provided by this PSP
Original uncertainty examples	Is it safe to do fat grafting? Can fat grafting encourage the growth of cancer cells because of putting tissue back into the breast area? ~ Is it ok to just have liposuction (tummy) and inject the fat removed to the breast site without resorting to a flap? ~ the availability of microfat injection should the need present ~ Less intrusive surgical Alternatives to reconstruction such as scar appearance improvement and fat injection to decrease concavity in the mastectomy region
Submitted by	8 x Patients and Care-givers, 1 x Clinician

Extra information provided by this PSP

Original uncertainty examples

Is it safe to do fat grafting? Can fat grafting encourage the growth of cancer cells because of putting tissue back into the breast area? ~ Is it ok to just have liposuction (tummy) and inject the fat removed to the breast site without resorting to a flap? ~ the availability of microfat injection should the need present ~ Less intrusive surgical Alternatives to reconstruction such as scar appearance improvement and fat injection to decrease concavity in the mastectomy region

Submitted by

8 x Patients and Care-givers, 1 x Clinician

PSP information
PSP unique ID	0109
PSP name	Post Mastectomy Breast Reconstruction
Total number of uncertainties identified by this PSP.	86 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	2 July 2019