title: Autologous fat grafting in onco-plastic breast reconstruction: A systematic review on oncological and radiological safety, complications, volume retention and patient/surgeon satisfaction.
abstract: OBJECTIVE
  This study presents an up-to-date overview of the literature on autologous fat grafting (AFG) in onco-plastic breast reconstruction, with respect to complications, oncological and radiological safety, volume retention and patient/surgeon satisfaction.
  
  
  BACKGROUND
  Although AFG is increasingly being applied in onco-plastic breast reconstruction, a comprehensive overview of the available evidence for this procedure is still lacking.
  
  
  METHODS
  A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was conducted. Case series, cohort studies and randomized controlled trials (RCTs) reporting on relevant outcomes of breast reconstruction with supplemental AFG were included.
  
  
  RESULTS
  In total, 43 studies were included reporting on 6260 patients with a follow-up period ranging from 12 to 136 months. The average locoregional and distant oncological recurrence rates after breast reconstruction with AFG were 2.5% (95% confidence interval (CI) 1.7-3.7) and 2.0% (95% CI 1.1-3.5), respectively. Fewer cysts and calcifications were seen on radiological images for this procedure than for other types of breast surgery. However, more biopsies were performed based on radiological findings (3.7% vs. 1.6%), and more cases of fat necrosis (9.0% vs 4.7%) were seen after treatment with AFG. The total complication rate of 8.4% (95% CI 7.6-9.1) is lower than those reported following other reconstructive breast procedures. The mean volume retention was 76.8% (range 44.7-82.6%) with a satisfaction rate of 93.4% for patients and 90.1% for surgeons.
  
  
  CONCLUSIONS
  AFG in breast reconstruction is a promising technique. Safety is not compromised as cancer recurrence and complications are not observed. Whether AFG interferes with radiological follow-up remains to be elucidated. Randomized trials with sound methodology are needed to confirm these conclusions.
authors.affiliation: Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Groen
authors.affiliation: Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 Amsterdam, The Netherlands.
authors.forename: V L
authors.initials: VL
authors.lastname: Negenborn
authors.affiliation: Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: D J W R
authors.initials: DJWR
authors.lastname: Twisk
authors.affiliation: Department of Biostatistics, Erasmus MC, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Rizopoulos
authors.affiliation: Medical Library, VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: J C F
authors.initials: JCF
authors.lastname: Ket
authors.affiliation: Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Smit
authors.affiliation: Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 Amsterdam, The Netherlands. Electronic address: M.mullender@vumc.nl.
authors.forename: M G
authors.initials: MG
authors.lastname: Mullender
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011834:Radiation Monitoring / Q000706:statistics & numerical data; D016378:Tissue Transplantation / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods
keywords: Autologous fat grafting; Breast; Efficacy; Reconstruction; Safety