Long-Term Efficacy and Safety of Fat Grafting Methods in Breast Reconstruction and Augmentation: A Systematic Review and Meta-Analysis

Fat grafting is increasingly used for breast reconstruction and augmentation, offering advantages over traditional implants and tissue flaps. Despite the growing popularity of techniques as cell-assisted lipotransfer and platelet-rich plasma, the existing evidence remains inconsistent due to diverse methodologies and reporting standards, making it difficult to draw clear conclusions on long-term efficacy and safety. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library databases up to April 2024. The study screened 805 studies, ultimately including ten randomized controlled trials involving 520 patients. Data extraction was performed using Excel, and bias was assessed utilizing the Cochrane collaboration's tool for assessing the risk of bias (RoB-2). Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The meta-analysis included ten randomized controlled trials involving 520 patients. The study demonstrated significant improvements in BREAST-Q domains, with mean differences (MD) in satisfaction with breasts (MD 67.52), psychosocial well-being (MD 73.77), physical well-being (chest) (MD 79.40), sexual well-being (MD 61.35), and overall satisfaction (MD 74.60). Breast enlargement (MD 6.10) and fat graft retention (MD 52.92) were also positive. No significant differences were found in pain outcomes. Complications included fat necrosis (13%), infection (11%), hematoma (3%), cyst formation (27%), seroma (4%), and calcification (6%). Additionally, contralateral new primary tumors (2%) and metastasis (1.0%) were noted, with 11% requiring reoperation. Fat grafting enhances patient-reported outcomes, including satisfaction and well-being, but variability in results and complications like fat necrosis and infection requires further research. Limited evidence underscores the need for larger, well-designed studies.