title: Cell assisted lipotransfer in breast augmentation and reconstruction: A systematic review of safety, efficacy, use of patient reported outcomes and study quality.
abstract: BACKGROUND
  Cell assisted lipotransfer serves as a novel technique for both breast reconstruction and breast augmentation. This systematic review assesses the efficacy, safety and use of patient reported outcome measures in studies involving cell assisted lipotransfer. We also carry out an objective assessment of study quality focussing on recruitment, follow-up and provide an up-to-date clinical trial landscaping analysis.
  
  
  METHODS
  Key electronic databases were searched according to PRISMA guidelines and pre-defined inclusion and exclusion criteria. Two independent reviewers examined the retrieved publications and performed data extraction.
  
  
  RESULTS
  3980 publications were identified. Following screening, 11 studies were included for full review, representing a total of 336 patients with a follow-up time ranging from six to 42 months. A degree of variation was noted in graft retention and reported satisfaction levels, although there were only three comparative studies with conflicting results. Complications occurred at a rate of 37%. Additionally, there was a paucity of objective outcomes assessments (e.g. 3D assessment modalities or validated patient reported outcome measures) in the selected studies.
  
  
  CONCLUSIONS
  Cell assisted lipotransfer is a surgical technique that is currently employed sparingly within the plastic & reconstructive surgery community. Presently, further technical and outcome standardization is required, in addition to rigorous randomized controlled trials and supporting long-term follow-up data to better determine procedural safety and efficacy. Routine use of more objective outcome measures, particularly 3D assessments and validated patient reported outcome measures, will also help facilitate wider clinical adoption and establish procedural utility.
authors.affiliation: School of Medicine, University of St. Andrews, St. Andrews, North Haugh, UK; The Oxford - UCL Centre for the Advancement of Sustainable Medical Innovation (CASMI), The University of Oxford, Oxford, UK.
authors.forename: Zeeshaan
authors.initials: Z
authors.lastname: Arshad
authors.affiliation: School of Medicine, University of St. Andrews, St. Andrews, North Haugh, UK.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Karmen
authors.affiliation: School of Medicine, University of Oxford, Oxford, UK.
authors.forename: Rajan
authors.initials: R
authors.lastname: Choudhary
authors.affiliation: Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, UK; The Oxford - UCL Centre for the Advancement of Sustainable Medical Innovation (CASMI), The University of Oxford, Oxford, UK.
authors.forename: James A
authors.initials: JA
authors.lastname: Smith
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Olivier A
authors.initials: OA
authors.lastname: Branford
authors.affiliation: The Oxford - UCL Centre for the Advancement of Sustainable Medical Innovation (CASMI), The University of Oxford, Oxford, UK; Said Business School, University of Oxford, Park End Street, Oxford, UK; Centre for Behavioral Medicine, UCL School of Pharmacy, University College London, Brunswick Square, London, UK; Harvard Stem Cell Institute, Divinity Avenue, Cambridge, MA, USA; USCF-Stanford Center of Excellence in Regulatory Science and Innovation (CERSI), 4th Street, USA; Department of Pediatrics, University of Oxford, Headley Way, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Brindley
authors.affiliation: The Oxford - UCL Centre for the Advancement of Sustainable Medical Innovation (CASMI), The University of Oxford, Oxford, UK; Department of Pediatrics, University of Oxford, Headley Way, UK.
authors.forename: David
authors.initials: D
authors.lastname: Pettitt
authors.affiliation: Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, UK; The Oxford - UCL Centre for the Advancement of Sustainable Medical Innovation (CASMI), The University of Oxford, Oxford, UK.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Davies
keywords: Adipose derived stem cells; Breast augmentation; Breast reconstruction; Cell assisted lipotransfer; Stromal vascular fraction