Evaluation of Effects of Autologous Fat Grafting on Aesthetic Outcomes in Breast Reconstruction Following Mastectomy: Effects of Reconstruction Type and Prior Radiotherapy Exposure

Background: Autologous fat grafting improves breast reconstruction aesthetics, yet impact relative to natural post-reconstructive changes remains poorly characterized.Methods: Retrospective analysis of 92 reconstructions (42 fat-grafted, 50 non-grafted) using BCCT.core and Harvard Scale assessments at 6-12 months.Results: Non-grafted reconstructions demonstrated significant deterioration (46%; BCCT.core p=0.027,Harvard p<0.001) uniformly across modalities.Conventional 3-week radiotherapy produced greater deterioration than 5-day regimens (p=0.036,p=0.024).Fat grafting reversed this trajectory, achieving 88.1% versus 4% complete complaint resolution (Mann-Whitney p<0.001; effect sizes 0.41-0.84)across all reconstruction types and radiotherapy exposures.Irradiated reconstructions demonstrated greatest gains.One to two sessions typically sufficed. Conclusion:Post-reconstructive deterioration should be anticipated.Fat grafting functions as regenerative intervention modifying biological maturation.Findings support proactive staged incorporation into algorithms, particularly for irradiated patients.