Autologous Fat Grafting (AFG) in Breast Cancer Patients – Oncologic Safety

Lo Torto F, et al. J Clin Med, 2024. PMID: 39124636.

Background: AFG is widely used in breast reconstruction for contour correction, volume restoration, and improved aesthetics. Its oncologic safety, especially risk of loco-regional recurrence (LRR), remains debated.

Methods:

• Systematic review per PRISMA, covering PubMed, Embase, Web of Science, and Cochrane (Nov 2023–Mar 2024).

• Included 40 studies (14,078 patients: 7,619 with AFG; 6,459 without AFG).

• Outcomes focused on LRR.

Results:

• LRR rates: 3.15% with AFG vs 5.3% without AFG.

• No overall increase in recurrence risk with AFG; some studies showed lower recurrence rates.

• Meta-analysis:

  • Unmatched studies: slight nonsignificant increase (RR 1.10, 95% CI 0.84–1.45).

  • Matched studies: significant reduction in recurrence risk with AFG (RR 0.71, 95% CI 0.55–0.91).

• Meta-regression: radiotherapy was associated with improved outcomes in AFG patients (p = 0.009). No significant effect from invasive histology or follow-up length.

Conclusions:

• AFG does not increase breast cancer recurrence risk and appears oncologically safe.

• Possible protective effect in radiotherapy-treated patients.

• Evidence limited by heterogeneity, retrospective designs, and lack of standardized reporting.

• Well-structured, prospective, long-term studies are needed.

Take-home: Current data support oncologic safety of AFG in breast reconstruction, with no increased risk of recurrence and potential benefit in selected patients. Counsel on imaging-visible changes (oil cysts, calcifications) and coordinate surveillance—especially in radiated breasts.