• Riaz A Agha, Alexander J Fowler, Christian Herlin, Tim E E Goodacre, and Dennis P Orgill.
• Department of Plastic Surgery, Pinderfields Hospital, The Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, UK; Department of Continuing Education, Kellogg College, University of Oxford, UK; Nuffield Department of Surgical Sciences, Kellogg College, University of Oxford, UK. Electronic address: mail@riazagha.com.
• J Plast Reconstr Aesthet Surg. 2015 Feb 1; 68 (2): 143-61.

BackgroundThere is growing interest in the use of autologous fat grafting (AFG) for breast reconstruction. Concerns have been raised regarding its effectiveness and safety.ObjectiveThe primary objective was to determine the oncological, clinical, aesthetic and functional, patient reported, process and radiological outcomes of AFG.MethodsA protocol was published on PROSPERO (CRD42013005254). Types of studies: All original studies.Types Of ParticipantsWomen undergoing reconstruction after surgery for breast cancer. Types of Interventions: AFG techniques for reconstruction. Types of outcome measures: Oncological, clinical, aesthetic and functional, patient reported, process and radiological. Search terms and keywords: The search strategy was devised to find papers regarding AFG for breast reconstruction.Data SourcesElectronic databases were searched from 1st January 1986 to 31st March 2014 including: PubMed, MEDLINE, EMBASE, SCOPUS, The Cochrane Library, and clinical trial registries. Identification and selection of studies: Title and abstract screening and full text assessment undertaken separately by independent researchers. Data extraction, collection and management: Data extracted by two researchers and stored in a standardised database.Results35 studies were included (3624 patients) with a high degree of patient and surgeon satisfaction over a mean of 1.9 sessions at 18 month follow-up. Fat necrosis was the commonest reported complication (4.4%), biopsy of a subsequent breast lump was required in 2.7% and an interval mammogram in 11.5%. The weighted mean recurrence rate was 4.4% at 24.6 months. Meta-analysis of comparative studies showed no significant difference in oncological event rates between AFG and non-AFG groups (p=0.10).ConclusionAFG is a potentially useful reconstructive tool, has a relatively low complication rate, with the majority of patients and clinicians satisfied or very satisfied with the results. Long term clinical and radiological follow-up is required. Further research is necessary to confirm oncological ramifications.Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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