Autologous Fat Transfer for complete Breast Reconstruction in irradiated breast cancer patients - A Systematic Review

AbstractBackground Autologous fat transfer (AFT) has emerged as a minimally invasive alternative for complete breast reconstruction. Its use after radiotherapy (RT) remains controversial due to concerns about graft retention, complications, and oncological safety. This systematic review aims to describe reported outcomes, safety data, and patient- and surgeon-reported results of total AFT breast reconstruction in irradiated patients. Methods A systematic search of PubMed, Embase, and Scopus (April 14th, 2025) was conducted following PRISMA guidelines. Studies on complete breast reconstruction using AFT in irradiated patients were included. Data extracted included patient demographics, RT parameters, AFT technique, number of sessions, injected volume, complications, recurrence, and satisfaction. Risk of bias was assessed using ROBINS-I. Results Eleven studies encompassing 783 patients were included, with irradiated cohorts ranging from 9 to 54 patients per study. Most reconstructions were delayed after RT, with varying surgical protocols. Mean follow-up ranged from 3 to 86.2 months. The mean number of AFT sessions ranged from 3.2 to 7.6 in irradiated patients. Mean per-session volumes ranged from 109.0 to 293mL, with mean cumulative volumes for completed reconstructions varying between 490 and 1109.2mL. In studies that included both irradiated and non-irradiated cohorts, some authors reported higher session counts and/or greater cumulative volumes in irradiated breasts, while others observed comparable values between groups. Most included studies reported minor complications and high satisfaction rates. Recurrence events were infrequently described. Conclusion This systematic review found that total breast reconstruction using AFT in irradiated patients appears feasible, and seems to be associated with high patient satisfaction and acceptable complication rates. However, the available evidence is predominantly retrospective and heterogeneous. Conclusions regarding long-term safety and effectiveness should therefore be interpreted cautiously, and further prospective studies with standardized reporting are warranted.