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Your Own Fat, Relocated

Rating

3 Star

Your Own Fat, Relocated

Our Review Summary

This story about renewed interest in surgically transferring body fat to enhance women’s breasts includes many warnings about potentially undesirable or harmful results.  But readers have to go through the entire story to get the full picture. By leading with references to a new, more positive professional attitude toward fat grafts (based on a task force report from the American Society of Plastic Surgeons published earlier this year) and featuring only patients who experienced good results, while leaving warnings and caveats for the bottom half of the story, casual readers are likely to get an unbalanced impression of this largely untested technique.

Indeed, the story fails to point out that there are no published studies of head-to-head randomized controlled trials comparing fat grafts to breast implants or other alternatives.

 

Why This Matters

Surgeons have broad authority to perform procedures, so the shift by the American Society of Plastic Surgeons to say that fat grafts to the breasts are no longer considered generally outside the bounds of acceptable practice could lead to a surge in marketing of this sort of procedure. Particularly in the case of cosmetic procedures that may not involve an insurance company or other authority, patients must often decide for themselves whether a surgeon has adequate skill and experience. It is important that stories about such procedures provide clear descriptions of the context of this sort of policy statement from a professional medical society, as well as clear guidance on how patients can identify competent providers.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story says that breast augmentation using fat grafts is usually more expensive than implants, but it does not include any price range for either type of procedure.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

While this story cautions against misleading promises made by some surgeons, the story then features only women who said they had positive results and strongly recommended the fat graft procedure, thus leaving readers with a one-sided perspective on likely outcomes.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The body of the story details several potential complications including long-term fat loss that undoes any initial benefits, as well as the appearance of cysts, masses, nodules and scarring. The story also notes concern about fat grafts potentially interfering with breast cancer screening.

However, the story should have at least referred to such problems higher in the story. It also neglected to mention reports of at least one death, as well as strokes and serious infections including septic shock, that were noted in the task force report.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story briefly mentions “the limited research on fat grafting to the breast,” and that the task force of the American Society of Plastic Surgeons signaled caution, but readers are not told just how weak the evidence is. The task force report that provides the basis for this story points out that there are no randomized controlled trials of fat grafting to the breast reported in the medical literature and that the evidence consists almost entirely of case reports and opinions from surgeons… the weakest forms of evidence. Indeed, the lead sentence of the task force report conclusion section reads: “Based on a review of the current literature and a lack of strong data, the task force cannot make specific recommendations for the clinical use of fat grafts.” That statement is far more cautious than the portrayal of the conclusions in this story.

(Current Applications and Safety of Autologous Fat Grafts: A Report of the ASPS Fat Graft Task Force http://www.plasticsurgery.org/Documents/Medical_Profesionals/Health_Policy/guiding_principles/Current-Applications-and-Safety-of-Autologous-Fat.pdf )

In addition, quoting a surgeon about generally beneficial results he presented at a medical meeting (that have not been peer-reviewed) may mislead readers who are unaware that many, if not most, studies presented at medical meetings are never actually published in leading medical journals. (See http://jama.ama-assn.org/cgi/content/full/287/21/2859 for more information.)

The story muddles its message near the end by mixing together different conditions and procedures, including enlarging breasts or filling small pockets with transfers of a patients own fats or injections of cells collected from donors before processing.

Does the story commit disease-mongering?

Not Applicable

This story does not address how women should make a decision about breast augmentation, whether through fat grafting, implantation or other means.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story included more than one independent expert and it identified the professional affiliations and some of the financial arrangements between experts who were quoted and companies or practices that profit from fat grafting.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story mentions breast implants as an alternative to fat grafting. However, except for lower cost, implants are portrayed as inferior to fat grafting in all of the comparisons. Here again, the story should have noted that there are no published studies that directly compare the experiences of women who received fat grafts with those who got implants, so as the task force report noted, no one can yet say with any confidence how the options compare.

Also, the story did not mention other alternatives that were noted in the task force report: “Alternative forms of nonsurgical and surgical management consist of injections of man-made substances to improve tissue volume (such as hyanuronic acid, polylactic acid, etc.), use of man-made implants, or other surgical procedures that transfer fat from the body (flaps).”

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

This story points out that only a handful of surgeons across the country offer breast augmentation using fat grafts and that the results are highly dependent on the skill and experience of the surgeon. The story also warns about doctors who promise unrealistic results.

However, the story offers readers no information about how to locate a surgeon who has a good track record.

Does the story establish the true novelty of the approach?

Satisfactory

The story describes fat grafts to the breast as a procedure that has been tried for decades, but that may gain popularity in part because the American Society of Plastic Surgeons eased its warnings against the procedure earlier this year .

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story includes information from several sources and so does not appear to be based on a news release.

Total Score: 5 of 9 Satisfactory

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