Nonvolumetric Indications for Fat Grafting in Breast Surgery and Breast Reconstruction: A Scoping Review

Autologous fat grafting (AFG) has growing interest for its versatility and efficacy in breast reconstruction. This scoping review aims to summarize the evidence for nonvolumetric indications of AFG in breast surgery and breast reconstruction.

MEDLINE, Embase, and Web of Science were searched from inception to March 2024. Articles were included if they used AFG in breast surgery for nonvolumetric indications. The primary outcome was the indication for AFG. Secondary outcomes included the capsular contracture (CC) rate, incidence of postmastectomy pain syndrome (PMPS), patient satisfaction, physician outcome measures, functional discomfort, and complications. A risk-of-bias assessment was performed.

After screening 7294 citations, 104 full-text articles were included. Indications included (1) CC; (2) PMPS; (3) contour deformities, asymmetry, and congenital deformities; (4) preparation of implant pocket; and (5) other indications. AFG is recommended for contour correction and congenital deformities. Pretreatment of radiated mastectomy flaps with AFG improved outcomes in implant-based breast reconstruction. Additional uses include gynecomastia, nipple reconstruction/sensation, and lymphedema. AFG did not significantly reduce CC rates overall (relative risk, 0.85 [0.62-1.17]; P = 0.31), but a significant reduction was observed in irradiated breasts (relative risk, 0.57 [0.4-0.82]; P < 0.01). AFG improved pain in PMPS patients (mean change in visual analog score -1.85 [-2.5 to -1.2], P < 0.001).

AFG shows promise for several emerging nonvolumetric breast applications in autologous and implant-based breast reconstruction. It may be a good adjunct in select patients, particularly those who have received radiation therapy.