title: Autologous Fat Grafting in the Breast: Critical Points and Technique Improvements.
abstract: BACKGROUND
  Breast augmentation or reconstruction is a major challenge in esthetic and reconstructive surgery. While autologous fat grafting (AFG) provides a natural filler and seems easy to harvest, AFG in breast surgery is still problematic especially due to the high resorption rate associated with megavolume transfer. Despite this pending issue, there is growing interest in this method, which is becoming more and more widespread, as can be seen by the recent increase in the number of clinical studies. This review aims to highlight recent knowledge in the technique of AFG to the breast and recent refined procedures to improve fat viability and long-term success of the graft.
  
  
  METHODS
  Clinical publications and trials of AFG to the breast from the past 5 years were examined. Attention was focused on the different AFG steps and the clinical outcomes, in order to highlight the strengths and weaknesses of the available protocols.
  
  
  RESULTS
  Recent studies have concentrated on new techniques to improve fat viability and graft intake. However, all of these studies use different protocols at each step of the procedure. Furthermore, results may vary depending on the technique used for fat harvesting and processing.
  
  
  CONCLUSIONS
  This review points out the recent advances in breast AFG techniques and their associated outcomes and complications. The bibliography has been carefully examined to reach a consensus so that recommendations could be made for each step of the technique with the aim of improving graft viability and long-term volume maintenance.
authors.affiliation: STEMCIS, Plateforme CYROI, Sainte Clotilde, Ile de la Réunion, France, vincent.hivernaud@hotmail.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Hivernaud
authors.forename: Bruno
authors.initials: B
authors.lastname: Lefourn
authors.forename: Jérôme
authors.initials: J
authors.lastname: Guicheux
authors.forename: Pierre
authors.initials: P
authors.lastname: Weiss
authors.forename: Franck
authors.initials: F
authors.lastname: Festy
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Girard
authors.forename: Regis
authors.initials: R
authors.lastname: Roche
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D064592:Autografts; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D020858:Tissue and Organ Harvesting