Total Breast Reconstruction with Autologous Fat Grafting after Mastectomy: A Systematic Review

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Biomaterials Science

Background:

• Autologous fat grafting is an alternative for total breast reconstruction post-mastectomy, especially for patients unsuitable for flap surgery or avoiding implants.
• This review evaluates technical aspects, assistive methods, complications, oncological safety, and patient satisfaction related to this technique.

Purpose of the Study:

• To systematically review the effectiveness and safety of autologous fat grafting for total breast reconstruction.
• To compare outcomes based on the use of assistive methods (none, reverse expansion, external expansion).
• To assess the impact of prior radiotherapy on fat grafting outcomes.

Main Methods:

• Systematic literature search of PubMed and Web of Science, including 16 eligible studies.
• Analysis of data from 996 breasts across 764 patients, focusing on session numbers, injection volumes, and complications.
• Subgroup analyses comparing outcomes with and without assistive methods, and assessing the effect of radiotherapy.

Main Results:

• A total of 3068 fat grafting sessions were analyzed, with an average of 3.5 sessions per breast and 744.2 mL total volume injected.
• Assistive devices significantly increased fat graft volume and reduced session numbers compared to no assistive method.
• The reverse expansion group showed the highest injection volume per session and fewest sessions, while external expansion was linked to higher complication rates. Irradiated patients needed more sessions but had similar complication rates.

Conclusions:

• Assistive techniques are crucial for enhancing the feasibility of total breast reconstruction via autologous fat grafting.
• These methods increase injectable volume and decrease the number of required sessions.
• Careful consideration of higher complication rates associated with external expansion devices is necessary.