title: Use of autologous fat grafting for breast reconstruction: a systematic review with meta-analysis of oncological outcomes.
abstract: BACKGROUND
  There is growing interest in the use of autologous fat grafting (AFG) for breast reconstruction. Concerns have been raised regarding its effectiveness and safety.
  
  
  OBJECTIVE
  The primary objective was to determine the oncological, clinical, aesthetic and functional, patient reported, process and radiological outcomes of AFG.
  
  
  METHODS
  A protocol was published on PROSPERO (CRD42013005254). Types of studies: All original studies.
  
  
  METHODS
  Women undergoing reconstruction after surgery for breast cancer. Types of Interventions: AFG techniques for reconstruction. Types of outcome measures: Oncological, clinical, aesthetic and functional, patient reported, process and radiological. Search terms and keywords: The search strategy was devised to find papers regarding AFG for breast reconstruction.
  
  
  METHODS
  Electronic databases were searched from 1st January 1986 to 31st March 2014 including: PubMed, MEDLINE, EMBASE, SCOPUS, The Cochrane Library, and clinical trial registries. Identification and selection of studies: Title and abstract screening and full text assessment undertaken separately by independent researchers. Data extraction, collection and management: Data extracted by two researchers and stored in a standardised database.
  
  
  RESULTS
  35 studies were included (3624 patients) with a high degree of patient and surgeon satisfaction over a mean of 1.9 sessions at 18 month follow-up. Fat necrosis was the commonest reported complication (4.4%), biopsy of a subsequent breast lump was required in 2.7% and an interval mammogram in 11.5%. The weighted mean recurrence rate was 4.4% at 24.6 months. Meta-analysis of comparative studies showed no significant difference in oncological event rates between AFG and non-AFG groups (p=0.10).
  
  
  CONCLUSIONS
  AFG is a potentially useful reconstructive tool, has a relatively low complication rate, with the majority of patients and clinicians satisfied or very satisfied with the results. Long term clinical and radiological follow-up is required. Further research is necessary to confirm oncological ramifications.
authors.affiliation: Department of Plastic Surgery, Pinderfields Hospital, The Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, UK; Department of Continuing Education, Kellogg College, University of Oxford, UK; Nuffield Department of Surgical Sciences, Kellogg College, University of Oxford, UK. Electronic address: mail@riazagha.com.
authors.forename: Riaz A
authors.initials: RA
authors.lastname: Agha
authors.affiliation: Barts and The London School of Medicine and Dentistry, QMUL, London E1 4NS, UK. Electronic address: ha09410@qmul.ac.uk.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Fowler
authors.affiliation: Department of Plastic and Reconstructive Surgery, Burns and Wound Healing, Lapeyronie University Hospital, 34295, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Herlin
authors.affiliation: Department of Plastic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford OX3 9DU, UK.
authors.forename: Tim E E
authors.initials: TE
authors.lastname: Goodacre
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D063868:Patient Outcome Assessment; D014182:Transplantation, Autologous
keywords: Autologous fat grafting; Breast; Breast conserving surgery; Breast surgery; Mastectomy; Reconstruction