The Efficacy of Fat Grafting on Treating Post-Mastectomy Pain with and without Breast Reconstruction: A Systematic Review and Meta-Analysis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Congratulations!

I was very interested to read a well designed and contemparary study about fat grafting for treatment of post mastectomy pain,

It covers all available literature and tries to eliminate confusing factors.

English language is fine and quality of presentation is high. 

I can only comment for a wider discussion that could cover the possible explanation why fat grafting can ease the pain for patients- if there is any.

Author Response

Thank you for your review. We will consider discussing the reason behind why fat grafting may ease pain for patients.

Reviewer 2 Report

Comments and Suggestions for Authors

This systematic review is well conducted and of high interest for the readers and I recommend publication after minor language edits.

Comments on the Quality of English Language

Please check the verbe tenses through the manuscript as they are not consistent.

There are also some spelling errors (i.e. page 5 line 163: co-founders should read confounders).

Author Response

Thank you for your review and comments.

Verb tenses and spelling errors have all been reviewed and corrected.

Reviewer 3 Report

Comments and Suggestions for Authors

The systematic review and meta-analysis performed by Chen et al. analyzes the effectiveness and safety of fat grafting for alleviating post-mastectomy pain syndrome (PMPS), a significant concern among breast cancer survivors.

Analyzing 9 studies with 812 participants, it shows that fat grafting significantly reduced pain scores, with minimal complications.

Specifically, the meta-analysis revealed a clinically significant decrease in the visual analogue scale (VAS) for pain in patients receiving fat grafting compared to those who did not.

This suggests that fat grafting could be a viable option for managing chronic PMPS, offering substantial pain relief; however, as the authors state in their conclusions, further research is needed to prove this evidence.

My congratulations to the authors; however, I have some comments:

- Are you actually investigating on the safety of fat grafting? What kind of analysis di you do to support the evidence of safeness after fat grafting in your meta-analysis ? I suggest you revise the title of your study;

- In the Introduction section (page 1, lines 34-40), you state that PMPS affects a large part of breast cancer survivors, that significantly affects the quality of life of these women, and that the prevalence remains high. I think that improving the quality of life is the main focus of the study and the authors should clearly state here that this represents the base of their study and they are currently investigating in this gap of literature to fix this issue;

- Again in the Introduction section, (line 41), you state that axillary lymph node dissection is a risk factor for PMPS. However, even if axillary lymph node dissection is currently part of breast cancer practice, there are some trials investigating the de-escalation of axillary dissection even in patients treated with mastectomy (i.e. PMID: 35279508). Please update your references;

- In Materials and methods section, did you conduct a review of literature also in Pubmed? If no, why? Please explain;

- Figure 1 is well done;

- Paragraph 3.3, I suggest to add a Table summarizing the findings;

- - In the Discussion section include the reference PMID: 36143318 for further context on breast reconstruction in patients undergoing mastectomy.

Author Response

In response to your comments:

Are you actually investigating on the safety of fat grafting? What kind of analysis di you do to support the evidence of safeness after fat grafting in your meta-analysis ? I suggest you revise the title of your study;

We have only qualitatively analyzed the safety profile of fat grafting. The title has been adjusted to reflect this.

In the Introduction section (page 1, lines 34-40), you state that PMPS affects a large part of breast cancer survivors, that significantly affects the quality of life of these women, and that the prevalence remains high. I think that improving the quality of life is the main focus of the study and the authors should clearly state here that this represents the base of their study and they are currently investigating in this gap of literature to fix this issue;

This has been added to our introduction.

Again in the Introduction section, (line 41), you state that axillary lymph node dissection is a risk factor for PMPS. However, even if axillary lymph node dissection is currently part of breast cancer practice, there are some trials investigating the de-escalation of axillary dissection even in patients treated with mastectomy (i.e. PMID: 35279508). Please update your references;

Thank you for providing us with this information. This has been incorporated into the introduction and referenced appropriately.

In Materials and methods section, did you conduct a review of literature also in Pubmed? If no, why? Please explain;

Our decision was based on the substantial overlap between PubMed and MEDLINE, as PubMed encompasses all records available in MEDLINE along with additional non-MEDLINE citations. Given this overlap, we prioritized searching MEDLINE through Ovid, considering it sufficient to capture the core biomedical literature pertinent to our review's objectives. To ensure a comprehensive search, we also included Embase and the Cochrane library.

Paragraph 3.3, I suggest to add a Table summarizing the findings;

We have included a supplementary table of our results.

In the Discussion section include the reference PMID: 36143318 for further context on breast reconstruction in patients undergoing mastectomy.

Thank you for shining light on this topic. We have modified our discussion section accordingly.