Autologous Fat Grafting for Breast Augmentation and Breast Remodeling: A Systematic Review and Meta-analysis of...

Autologous fat grafting (AFG) is increasingly used for aesthetic breast augmentation and remodeling because it provides natural tissue augmentation without permanent implants. This systematic review and meta-analysis evaluated complications, radiologic outcomes, graft retention, and patient satisfaction following AFG. A PRISMA 2020-compliant search identified 40 primary clinical studies including 5,684 patients. The risk of bias was assessed using the RoB2, ROBINS-I, and Newcastle-Ottawa Scale. Random-effects meta-analysis used restricted maximum likelihood estimation as the primary model, with Hartung-Knapp adjustment and DerSimonian-Laird and Paule-Mandel estimators in sensitivity analyses. Mean follow-up exceeded 6 months. The pooled complication rate was 25.9% (95% CI, 22.4-29.6), mainly consisting of minor radiologic or palpable findings; fat necrosis was the most common adverse event. Benign radiologic findings included fat necrosis (8.8%) and calcifications (1.1%), without evidence of impaired cancer detection. Mean injected fat volume was 310 mL per breast. Twelve-month volume retention was 61.3% (95% CI, 57.1-65.4), with higher retention in SVF/PRP-enriched grafts (68.9% vs 56.1%; p<0.01), although evidence remained heterogeneous. Patient satisfaction was 93.1% (95% CI, 90.4-95.8), despite heterogeneous PROMs. Heterogeneity was substantial for complications (I2=78%; τ2=0.021; Q=177.6; p<0.001) and volume retention (I2=82%; τ2=0.067; Q=216.4; p<0.001), and moderate for radiologic outcomes (I2=52%; τ2=0.008; Q=81.3; p<0.001), reflecting variability in techniques, imaging, processing, enrichment, assessment methods, and follow-up. Current observational evidence supports favorable safety profiles; however, oncologic outcomes were not quantitatively pooled, and prospective comparative studies with standardized reporting are required.