Autologous Fat Grafting in Onco-Plastic Breast Reconstruction; A Systematic Review on Oncological and Radiological safety, Complications, Volume Retention, and Patient/Surgeon Satisfaction

Publication date: Available online 29 March 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): J. Groen, V.L. Negenborn, D.J.W.R. Twisk, PhD. Rizopoulos, J.C.F. Ket, J.M. Smit, M.G. Mullender
ObjectiveThis study aims to give an up-to-date overview of literature on autologous fat grafting (AFG) in onco-plastic breast reconstruction, with regard to complications, oncological and radiological safety, volume retention, and patient/surgeon satisfaction.BackgroundAlthough AFG is increasingly being applied in onco-plastic breast reconstruction, a comprehensive overview of the available evidence of this procedure is still lacking.MethodsA systematic review following the PRISMA statement was conducted. Case series, cohort studies, and RCTs reporting on relevant outcomes of breast reconstruction with supplemental AFG were included.ResultsIn total, 43 studies were included reporting on 6260 patients with a follow-up ranging from 12 to 136 months. The average locoregional and distant oncological recurrence rates after breast reconstruction with AFG were 2.5% (95% CI 1.7–3.7) and 2.0% (95% CI 1.1–3.5). On radiological images fewer cysts and calcifications were seen compared to other types of breast surgery. However, more biopsies were performed based on radiological findings (3.7% vs. 1.6%), and more fat necrosis (9.0% vs. 4.7%) was seen after treatment with AFG. The total complication rate of 8.4% (95% CI 7.6–9.1) is lower than those reported after other reconstructive breast procedures. The mean volume retention was 76.8% (range 44.7%–82.6%) with a satisfaction rate of 93.4% for patients and 90.1% for surgeons.ConclusionsAFG in breast reconstruction is a promising technique. Safety does not seem to be compromised as cancer recurrence and complications are not increased. Whether AFG interferes with radiological follow-up is still open to discussion. Randomized trials with sound methodology are necessary to confirm these cautious conclusions.



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