Autologous fat grafting in breast augmentation: A systematic review highlighting the need for clinical caution

Background: Autologous fat grafting (AFG) is a breast augmentation method for treating volume and contour abnormalities. This systematic review aims to summarize complications, radiological safety, volume retention, and patient satisfaction associated with AFG.

Methods: PubMed, EMBASE, Google Scholar, Cochrane CENTRAL, Wiley library, clinical key/Elsevier, and EBSCO databases were searched for relevant studies from January 2009 to March 2022. Articles describing AFG for breast augmentation were selected based on pre-determined inclusion and exclusion criteria. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The ROBINS-I assessment was used to assess the quality of studies and the risk of bias was measured using the ACROBAT- NRSI.

Results: Total of 35 studies comprising 3757 women were included. The average follow-up duration was 24.5 months (range, 1-372 months). The overall complication rate was 27.8%, with fat necrosis making up 43.7% of all complications. Average fat volume injected was 300mls (range: 134-610ml) and average volume retention was 58% (range: 44-83%). Volume retention was greater with supplementation of fat with plasma-rich-protein (PRP) and stromal vascular fractioning (SVF). The most common radiological changes were fat necrosis (9.4%) and calcification (1.2%). After follow-up of one year, patient satisfaction was on average 92% (range; 83.2-97.5%). The included studies were of good quality and consisted of a moderate risk of bias.

Conclusions: AFG was associated with an overall complication rate of 27.8%, and additional supplementation of fat with PRP and SVF may improve graft survival. Despite poor volume retention being a persistent drawback patient satisfaction remains high. Despite volume retention being a persistent drawback, patient 326 satisfaction remains high. Future studies should improve follow-up durations to confidently assess the oncological safety of AFG in breasts.

References
Wetterau, M., Szpalski, C., Hazen, A., Warren, S. M. Autologous fat grafting and facial reconstruction. Journal of Craniofacial Surgery 2012;23:315-318.
Rubin, J. P., Coon, D., Zuley, M., et al. Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study. Plast Reconstr Surg

Breast

PSTM 2024