Oncologic Safety in Autologous Fat Grafting Reconstruction after Breast Conservation Treatment: A Systematic Review and Meta-analysis

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PURPOSE: Autologous fat grafting (AFG) reconstruction is a widely used method to correct defects after breast conservation treatment (BCT) that has gained popularity within the last decade. Even though it results in aesthetically pleasing outcomes with minimally invasive surgery, the oncological outcomes of the procedure are still being researched. The purpose of this systematic review is to analyze the literature to compare BCT and AFG versus BCT only with cancer recurrence and procedure complications. METHODS: The systematic review was conducted using the PubMed Database with articles from 1970 to 2021. The main search terms used were ‘mammaplasty’, ‘breast conservation’, ‘breast cancer’, ‘fat grafting’, and ‘neoplasm recurrence.’ The inclusion criteria were fat grafting only, partial breast reconstruction, and cancer recurrence. The exclusion criteria were all full breast reconstruction procedures. The statistical analysis was done using patients who received AFG versus no AFG in the BCT population in order to compare complications, cancer recurrence, and metastasis. RESULTS: The PubMed search strategy yielded a total of 146 articles. After applying inclusion and exclusion criteria, a total of 15 articles were used for analysis, with a total of 900 BCT only patients and 1063 BCT AFG patients. Based on the pooled meta-analysis, in the BCT only patients, 4.8% had cancer recurrence and 4.8% had metastasis, and for the BCT and AFG patients, 3% had cancer recurrence and 6.9% had metastasis. The average length of follow up time for BCT only is 58.73 months and for BCT and AFG is 55.24 months. Patients with BCT only versus BCT and AFG showed no statistically significant difference in total cancer recurrence (P=0.99), local cancer recurrence (P=0.84), and metastasis (P=0.36). The fat necrosis and oil cyst rate for BCT only was 21.3 % and for BCT and AFG it was 19.2%. The complication rates for fat necrosis and oil cysts were not statistically different between BCT versus BCT and AFG (P=0.44). CONCLUSION: The results show no significant difference in cancer recurrence or metastasis in the BCT only group versus BCT and AFG, showing that fat grafting is not only an aesthetically pleasing and minimal surgery, but it has safe outcomes with no differences in complications.