Outcomes and Complications of Autologous Fat Transfer for Total Breast Reconstruction and Augmentation: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND

Autologous fat transfer (AFT) for total breast reconstruction and augmentation is increasingly applied due to its advantages over implants and autologous flaps, including minimal invasiveness, minimal donor-site morbidity, and quick recovery. However, AFT is not without complications when applied for full breast reconstruction, underscoring the need to evaluate its safety and effectiveness. This systematic review and meta-analysis assesses the oncological and surgical safety of AFT as a stand-alone procedure for total breast reconstruction and augmentation, including the effectiveness of different AFT techniques and patient-reported satisfaction.

METHODS

A MEDLINE, Embase, and Web of Science search (from inception to December 2024) focusing solely on randomized controlled trials evaluating AFT outcomes for total breast reconstruction or augmentation was performed. Animal studies, partial reconstruction/augmentation, and combined procedures were excluded. Data were extracted and analyzed using random-effects meta-analyses, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Risk of bias was assessed using the Cochrane tool.

RESULTS

From 2323 identified articles, 9 randomized controlled trials were included. AFT showed fewer surgical complications compared with implant-based reconstruction. Oncological safety was similar between AFT and implant-based reconstruction. AFT-related complications (eg, oil cysts, fat necrosis) occurred at similar rates across different AFT techniques, but using fat sedimentation and retropectoral grafting were associated with fewer complications. Meta-analysis showed that all enriched AFT techniques-including stromal vascular fraction and botulinum toxin-improved fat retention rates.

CONCLUSIONS

AFT is an effective and technically and oncologically safe option for total breast reconstruction and total breast augmentation. However, limited follow-up duration prevents definitive conclusions on long-term oncological outcomes.