Fat survival following autologous fat transfer to the native breast: A systematic review and meta-analysis

Autologous fat transfer (AFT) is increasingly used for breast augmentation, either for primary augmentation or symmetrization in the unaffected, native breasts following breast reconstruction. However, the incidence of fat necrosis and graft revascularization in this population remains unclear. A systematic review and meta-analysis were conducted to quantify these outcomes. Secondary outcome measures included the need for additional fat grafting and rate of subsequent biopsies.

A systematic search of the MEDLINE, Scopus, Embase, CINAHL, Cochrane Library, and Google Scholar databases was conducted. Pooled weighted proportions with 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic.

A total of 47 studies were included with a combined participant pool of 4425. The pooled incidence of fat necrosis per participant was 4.66% (95% CI [1.88, 8.35], I² = 91%). Fat graft uptake per breast was 53.26% (95% CI [46.32, 60.20], I² = 99.7%). The need for additional AFT was 11.83% (95% CI [5.40, 20.12], I² = 95.9%). The rate of future biopsies was 5.55% (95% CI [0.53, 13.92], I² = 81.6%). Considerable heterogeneity was observed across studies.

AFT to the native breast for primary breast augmentation or symmetrization after contralateral breast reconstruction is a safe procedure with a low incidence of fat necrosis and an acceptable degree of fat retention. These findings highlight the importance of counseling patients regarding the likelihood of volume loss and potential need for multiple sessions to achieve satisfactory outcomes.