“Total Breast Reconstruction with Autologous Fat Grafting after Mastectomy: a Systematic Review”

Background: Total breast reconstruction with autologous fat grafting after mastectomy has emerged as an alternative for patients who are not candidates for flap surgery or prefer to avoid implants. This review aims to evaluate its technical considerations, role of assistive methods, complication profile, oncological safety and patient satisfaction. Method: A systematic search of PubMed and Web of Science identified 16 eligible studies from a total of 4316 publications. Only studies that performed total breast reconstruction with autologous fat grafting—or reported separable data on such cases—were included. Data on session numbers, injection volumes, and complications were analyzed. Subgroup analyses compared outcomes among three groups: no-assistive method, reverse expansion, and external expansion. The impact of prior radiotherapy was also assessed. Results: A total of 3068 fat grafting sessions were analyzed across 996 breasts from 764 patients. The mean number of sessions per breast was 3.5, with 227.6 mL of fat injected per session and a total volume of 744.2 mL. Total and per session fat graft volume was significantly lower in patients without an assistive device. Highest mean injection volume per session and lowest session count was observed in the reverse expansion group. Minor and major complication rates were significantly higher in the external expansion group. Irradiated patients required more sessions but had similar complication rates. Conclusion: Assistive techniques improve the feasibility of total breast reconstruction with autologous fat grafting by increasing injectable volume and reducing the number of sessions. Higher complication rates associated with external devices warrant careful consideration.