Table 2

Prior reviews of autologous fat grafting (AFG) to the breast

ReviewDatabases included and years searchedInclusion criteriaStudies includedKey findings
Leopardi et al47PubMed, EMBASE, Current Contents, The Cochrane Library and the York Centre for Reviews and Dissemination.
January 2001 to 14 January 2009
Comparative studies comparing the safety and/or effectiveness of AFG with saline or cohesive silicone implants (with either smooth or textured walls) in adult women undergoing breast augmentation for cosmetic indications (not reconstructive)532 found in the search and 18 were included in the reviewComplications associated with AFG occurred in only a small proportion of patients, including fat necrosis, cysts and lumps. Reabsorption of fat occurred to varying degrees. Patient satisfaction following AFG was high with volume limitation being the main discomfort. No data examining the effect of complications such as microcalcification on long-term mammographic and cancer-related outcomes was identified
Claro et al48MEDLINE, EMBASE, SciELO and the Cochrane Library, July 1986 to June 2011Both augmentation and reconstructive indications were included302 articles found in the search and 60 were included in the review (4601 patients)The incidence of clinical complications was 3.9% of 3015 women (21 studies)—the majority being induration and palpable nodularity. Radiographic abnormalities were found in 13% of 2560 patients (17 studies), the majority were cysts. Local recurrence of breast cancer occurred in 2.3% of 616 women (three studies). The authors concluded that oncological safety remains unclear
Rosing et al49MEDLINE only
Time limits not stated
Inclusion criteria not well defined. Excluded studies that exclusively used AFG for contour irregularities postbreast reconstruction115 articles found in the search and 17 included in the review (1658 patients)The majority of patients included were satisfied with the results but nine studies did not report patient satisfaction
 Gutowski23PubMed and the Cochrane Database of Systematic Reviews
Time limits not stated
Search limits restricted results to English-language articles that were indexed as human studies, clinical trials, randomised controlled trials, systematic reviews, case series, or case reports. French language articles were included if they were relevant to the breast, which was the main focus of the task force187 found in the search and 110 included in the reviewThe authors recognise the lack of strong data but recommended that fat grafting may be considered for breast augmentation and correction of defects associated with medical conditions and previous breast surgeries; however, results are dependent on technique and surgeon expertise, which is not standardised. Patient satisfaction was typically good to excellent. Infection being a primary concern, the need for sterile technique was emphasised. Other complications included seroma and haematoma. Two cases of breast cancer were reported after fat grafting. The review recommended that caution should be exercised when considering high-risk patients (ie, those with risk factors for breast cancer: BRCA-1, BRCA-2 and/or personal or familial history of breast cancer).
However there were no reports suggesting an increased risk of malignancy associated with fat grafting. There is a potential risk of fat grafts interfering with breast physical examination or breast cancer detection. Baseline mammography is recommended but no evidence was found that strongly suggests interference with breast cancer detection through mammography.
Indications for fat grafting were heterogeneous, including micromastia, tuberous breasts, postaugmentation and postmastectomy deformities, Poland's syndrome, nipple reconstruction and radiotherapy damage