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The Safety and Efficacy of Autologous Fat Grafting as a Surgical Strategy in

Cosmetic Breast Enhancement: A Systematic Review


Safirina Ramakrishnan D ,
1 A 2
1The University of Melbourne, Melbourne, Australia
2Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Melbourne, Australia

Introduction 1 RCT study considered as a “good” study according to PEDro Scale (7 points) and 8
Autologous fat grafting is a technique that involves fat transfer cohort studies had an average score of 7.86 (1 study accounted as 7*, 6 studies
from donor areas (e.g. abdomen, buttocks, thighs) by removal of accounted as 8*) on the NOS Scale.
fat (liposuction) to desired recipient areas.
Author (Publication Year) Main Findings
There are three main steps of the procedure: fat harvesting, fat
Auclair et al. (2015) The incidence of early and late complications is low
processing, and fat injecting.
Cheng Li et al. (2014) Significantly improved breasts in 47 patients (44.8%)
Fat transfer is a less invasive surgical strategy compared to
implants, the alternative method for cosmetic breast Dali Mu et al. (2009) Nodules are found in all patients prior to 10 months of
enhancement. surgery
Kamakura et al. (2011) Improved and stable circumferential breast
As the popularity of autologous fat grafting to the breast has measurement in all patients
increased, oncological safety concern were raised due to breast Khouri et al. (2012) Good graft survival rates and minimal occurrence of
malignancy risk. complications
Rubin et al. (2011) Few radiographic abnormalities are found
Spear et al. (2014) No acute complications in all patients
Aims Zheng et al. (2007) Highly improved breast contour in 28 patients (42.4%)
To evaluate studies on the
safety and efficacy of Table 1. Safety and Efficacy of Autologous Fat Grafting
autologous fat grafting to Author Study Design Follow-Up Intervention Mean Breast Volume of Fat
determine a better surgical (Months) (Cannula) Injected (Right/Left; ml)
strategy of cosmetic breast
enhancement Auclair et al. Cohort 5 3 mm 55/55
Figure 1. Fat Injection into Breast Area Cheng Li et al. Cohort 18 Coleman 185/185
Methods Dali Mu et al. Cohort 15 Coleman 175/175
Kamakura et al. Cohort 9 2.5 mm 245/235
A comprehensive literature search was conducted on September
Khouri et al. Cohort 44 Coleman 233/233
15th 2017 using the following electronic databases: PubMed,
Cochrane Library, and Clinical Key. Rubin et al. RCT 12 Coleman 263.3/263.3
Spear et al. Cohort 12 Coleman 243/243
Inclusion Criteria Zheng et al. Cohort 37 Coleman 87/87
• Study design and Intervention Table 2. Comparisons Between Studies
Eight studies were eligible in providing autologous fat grafting
Safety Outcomes
intervention on patients undergoing cosmetic breast
• Six studies by Cheng Li et al., Dali Mu et al., Khouri et al., Rubin et al., Spear et al.,
enhancement between year 2007-2017.
• Participants and Zheng et al. used a specific 3 mm blunt-edged, 2 holes Coleman cannula as
Women undergoing cosmetic breast enhancement. their study intervention.
• Outcome Measure • All of the included studies have performed close follow-up with MRI and found a
Safety aspects (post-operative morbidities, calcification, small proportion of complications such as cyst formation and fat necrosis.
radiological changes, association with breast cancer recurrence) • Most of the cysts and fat necrosis appeared after more than a year postoperatively.
and efficacy aspects (fat retention, reoperation, patient and • There was one study by Khouri et al. reported minimal occurrence of infection with
surgeons’ satisfaction, patient’s quality of life) of autologous fat good graft survival rates.
grafting procedure. • All studies with cyst formation showed benign calcifications including typically thin-
Exclusion Criteria walled calcification. There were no pleomorphic calcifications found.
Studies written in a language other than English and animal
studies. Efficacy Outcomes
• The average fat retention over five reported studies in the total of eight studies was
Methodological Quality
51% over minimal period of 1 postoperative year. There was no association
PEDro Scale for 1 RCT study and The Newcastle-Ottawa Scale
concerning volume retention to be found.
(NOS) for 7 cohort studies
• There were relatively high patients’ satisfaction ranging from 75% and 100% (𝜇 =
Results 85.3%) from five out of eight included studies.
Records identified through • Three out of eight included studies reported relatively moderate to high level of
databases (n = 728) mean surgical satisfaction ranging from 69% until 100% (𝜇 = 53%)
Discussion and Conclusion
Records after duplicates Records excluded (n = 69) • There is no current evidence of increased occurrence or reoccurrence of breast
removed (n = 555) • Commentary articles (n = 5) malignancy regarding the procedure therefore oncologic follow-up is important to
• Irrelevant title and abstract indicate any potential breast cancer risk
(n = 21)
• The majority of reported complications are of low morbidity; the procedure itself has
• Non-English publication (n =
Records screened 11)
a good long-term safety
(n = 173) • Non-breast studies (n = 32) • In term of techniques, autologous fat grafting is different among surgeons and
lacking standardization
• Provides high satisfaction from the patients and surgeons with small to moderate
Full text eligibility Records excluded (n = 97) breast volume gain
screening (n = 104) • Did not answer research • Appears to be a safe and effective surgical technique for cosmetic breast
question (n = 72) enhancement surgery
• Not relevant to the topic (n
= 25) Acknowledgement
Final 8 studies included in this review
I would like to express my sincerest gratitude to Prof Anand Ramakrishnan MBBS,
(7 non-RCT and 1 RCT)
MD, MPH, FRACS, Dr. Krithika Sundharam, and Dr. Anita Hovarth for their guidance
Figure 2. Flowchart of Article Selection Process and encouragement throughout the making of this systematic review and poster.