Fat grafting in autologous breast reconstruction: applications, outcomes, safety, and complications

Abstract

Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures. Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability; it can be used independently to replace more invasive flap procedures or implants, or as an adjunct for smaller volume supplementation. The breadth of applications in the breast necessitates diversity in technique and approach, and while there is no universally agreed-upon protocol, basic principles have guided the evolution of some commonly adopted tenets. Broadly, fat grafting outcomes are highly favorable but dependent on patient and procedure factors, requiring learned patient selection and expertise in recipient site assessment. Common complications from fat grafting, such as fat necrosis and the development of nodules, are particularly troublesome for post-oncologic patients, requiring considerable pre-surgical consultation for patient education and managing expectations. In addition to volume and contour augmentation, fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or post-mastectomy pain syndrome, improved skin quality and reduced fibrosis following radiation, and possible anti-tumorigenic effects. New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma. Preclinically, research towards safe and effective regenerative medicine approaches is actively underway, with the ultimate goal of achieving predictable and increased graft retention, reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.

Keywords

Fat grafting / fat transfer / autologous breast reconstruction / implant reconstruction / lipo-injection / breast augmentation / graft survival / skin expansion / mastectomy / post-mastectomy pain / breast fibrosis / capsular contracture

References

[1] U.S. Department of Labor. Women’s health and cancer rights act of 1998. Available from: https://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/downloads/WHCRA_Statute.pdf [Last accessed on 29 Mar 2023]

[2] Miseré RM,Claassens EL,Piatkowski AA.Breast-related and body-related quality of life following autologous breast reconstruction is superior to implant-based breast reconstruction - a long-term follow-up study.Breast2021;59:176-82 PMCID:PMC8287213

[3] Metcalfe KA,Quan ML.Changes in psychosocial functioning 1 year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction.Ann Surg Oncol2012;19:233-41 PMCID:PMC9444701

[4] Dean C,Forrest AP.Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy.Lancet1983;1:459-62

[5] Holly P,Taylor A.Immediate breast reconstruction and psychological adjustment in women who have undergone surgery for breast cancer: a preliminary study.Psychol Health Med2003;8:441-52

[6] Noone RB,Hayward CZ.Patient acceptance of immediate reconstruction following mastectomy.Plast Reconstr Surg1982;69:632-40

[7] Carr TL,Cochran D,Holtslander L.Exploring women’s support needs after breast reconstruction surgery: a qualitative study.Cancer Nurs2019;42:E1-9 PMCID:PMC6392201

[8] Sufyani MA, Al Hargan AH, Al Shammari NA, Al Sufyani MA. Autologous fat transfer for breast augmentation: a review.Dermatol Surg2016;42:1235-42

[9] Davis MJ,Abu-Ghname A.Application of fat grafting in cosmetic breast surgery.Semin Plast Surg2020;34:24-9 PMCID:PMC7023973

[10] Graf RM,Pace D,Pazio ALB.Breast auto-augmentation (mastopexy and lipofilling): an option for quitting breast implants.Aesthetic Plast Surg2019;43:1133-41

[11] Spear SL,Lockwood MD.Fat injection to correct contour deformities in the reconstructed breast.Plast Reconstr Surg2005;116:1300-5

[12] Manconi A,Chahuan B.Total breast reconstruction with fat grafting after internal expansion and expander removal.Ann Plast Surg2017;78:392-6

[13] Siotos C,Prasath V.Pure fat grafting for breast reconstruction: An alternative autologous breast reconstruction.Breast J2020;26:1788-92

[14] Tomouk T,Azizi A,Brickley EB.Donor site morbidity in DIEP free flap breast reconstructions: a comparison of unilateral, bilateral, and bipedicled surgical procedure types.J Plast Reconstr Aesthet Surg2017;70:1505-13

[15] Tachi M.Choice of flaps for breast reconstruction.Int J Clin Oncol2005;10:289-97

[16] Flitcroft K,Spillane A.Making decisions about breast reconstruction: a systematic review of patient-reported factors influencing choice.Qual Life Res2017;26:2287-319

[17] Hangge PT,Mohsen A.Making an informed choice: Which breast reconstruction type has the lowest complication rate?.Am J Surg2019;218:1040-5

[18] Whyte S,Chan HF.Cognitive bias and therapy choice in breast reconstruction surgery decision-making.Plast Reconstr Surg2022;149:629e-37e

[19] Whyte S,Chan HF.Knowledge, consultation time, and choice in breast reconstruction.Br J Surg2021;108:e168-9

[20] Ananthakrishnan P.Options and considerations in the timing of breast reconstruction after mastectomy.Cleve Clin J Med2008;75 Suppl 1:S30-3

[21] Surgeons ASoP. 2020 plastic surgery statistics. In: plastic surgery statistics. American Society of Plastic Surgeons; 2020, p. 26. Available from: https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf [Last accessed on 29 Mar 2023]

[22] Kappos EA,Regan MM.Prepectoral versus subpectoral implant-based breast reconstruction after skin-sparing mastectomy or nipple-sparing mastectomy (OPBC-02/ PREPEC): a pragmatic, multicentre, randomised, superiority trial.BMJ Open2021;11:e045239 PMCID:PMC8413865

[23] Turner A,Davis MJ,Hanson SE.Fat grafting in breast reconstruction.Semin Plast Surg2020;34:17-23 PMCID:PMC7023975

[24] Blacam C, Momoh AO, Colakoglu S, Tobias AM, Lee BT. Evaluation of clinical outcomes and aesthetic results after autologous fat grafting for contour deformities of the reconstructed breast.Plast Reconstr Surg2011;128:411e-8e

[25] Razzouk K,Al Khori N,Chouchane L.Breast reconstruction combining lipofilling and prepectoral prosthesis after radiotherapy.Plast Reconstr Surg Glob Open2020;8:e2659 PMCID:PMC7572071

[26] Kalaaji A,Baumgartner M.Aesthetic breast augmentation using autologous fat grafting: indications, patient assessment, and comparison between different processing methods in 204 cases. In: Amin Kalaaji, editor. Plastic and aesthetic regenerative surgery and fat grafting:Springer;2022.p.937-56.

[27] Pantelides NM.Rippling following breast augmentation or reconstruction: aetiology, emerging treatment options and a novel classification of severity.Aesthetic Plast Surg2018;42:980-5

[28] Kanchwala SK,Conant EF.Autologous fat grafting to the reconstructed breast: the management of acquired contour deformities.Plast Reconstr Surg2009;124:409-18

[29] Turner A,Davis MJ,Hanson SE.Fat grafting in breast reconstruction.Semin Plast Surg2020;34:17-23.

[30] Davis MJ,Abu-Ghname A,Chamata E,Winocour SJ.Application of Fat Grafting in Cosmetic Breast Surgery.Semin Plast Surg34:24-9 PMCID:PMC7023973

[31] Mojallal A,Shipkov C.Improvement of skin quality after fat grafting: clinical observation and an animal study.Plast Reconstr Surg2009;124:765-74

[32] Gronovich Y,Maisel-Lotan A.Hybrid prepectoral direct-to-implant and autologous fat graft simultaneously in immediate breast reconstruction: a single surgeon’s experience with 25 breasts in 15 consecutive Cases.Plast Reconstr Surg2022;149:386e-91e

[33] Sforza M.Hybrid implant and grafted fat breast augmentation: designing the pathway to a future with breasts free of silicone breast implants.Aesthet Surg J2021;41:NP1473-85 PMCID:PMC8564703

[34] Nahabedian MY.Factors to consider in breast reconstruction.Womens Health (Lond)2015;11:325-42

[35] Saulis AS,Fine NA.A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures.Plast Reconstr Surg2007;119:1669-76

[36] Eltahir Y,Sadok N,de Bock GH.Outcome of quality of life for women undergoing autologous versus alloplastic breast reconstruction following mastectomy: a systematic review and meta-analysis.Plast Reconstr Surg2020;145:1109-23

[37] Siqueira HFF,Lessa Filho RDS.Patient satisfaction and quality of life in breast reconstruction: assessment of outcomes of immediate, delayed, and nonreconstruction.BMC Res Notes2020;13:223 PMCID:PMC7169023

[38] Kolasinski J.Total breast reconstruction with fat grafting combined with internal tissue expansion.Plast Reconstr Surg Glob Open2019;7:e2009 PMCID:PMC6554159

[39] Elliott LF,Hartrampf CR.The lateral transverse thigh free flap: an alternative for autogenous-tissue breast reconstruction.Plast Reconstr Surg1990;85:169-78

[40] Sinna R,Garson S,Toussoun G.Breast fat grafting (lipomodelling) after extended latissimus dorsi flap breast reconstruction: a preliminary report of 200 consecutive cases.J Plast Reconstr Aesthet Surg2010;63:1769-77

[41] Bennett KG,Kim HM.Association of fat grafting with patient-reported outcomes in postmastectomy breast reconstruction.JAMA Surg2017;152:944-50 PMCID:PMC5668871

[42] Thekkinkattil DK,McManus PL.Feasibility of autologous fat transfer for replacement of implant volume in complicated implant-assisted latissimus dorsi flap breast reconstruction.Ann Plast Surg2015;74:397-402

[43] Missana MC,Barreau L.Autologous fat transfer in reconstructive breast surgery: indications, technique and results.Eur J Surg Oncol2007;33:685-90

[44] Bonomi R,Rapisarda IF,Sajid MS.Role of lipomodelling in improving aesthetic outcomes in patients undergoing immediate and delayed reconstructive breast surgery.Eur J Surg Oncol2013;39:1039-45

[45] Niddam J,Hersant B.Primary fat grafting to the pectoralis muscle during latissimus dorsi breast reconstruction.Plast Reconstr Surg Glob Open2016;4:e1059 PMCID:PMC5142472

[46] Chan CW,Macmillan RD.Autologous fat transfer-a review of the literature with a focus on breast cancer surgery.J Plast Reconstr Aesthet Surg2008;61:1438-48

[47] Dayal A,Hsu JT.Fat grafting in aesthetics.Clin Dermatol2022;40:35-44

[48] KA; ASPS Fat Graft Task Force. Current applications and safety of autologous fat grafts: a report of the ASPS fat graft task force.Plast Reconstr Surg2009;124:272-80

[49] Coleman SR.Primary breast augmentation with fat grafting.Clin Plast Surg2015;42:301-6, vii

[50] Branford OA,Hartmann CEA,Floyd D.Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction: a comparative analysis of two techniques.Plast Reconstr Surg2013;132:737-48

[51] Zhu L,Vijayasekaran A.Maximizing the volume of latissimus dorsi flap in autologous breast reconstruction with simultaneous multisite fat grafting.Aesthet Surg J2016;36:169-78

[52] Jeon BJ,Lim SY.Risk factors for donor-site seroma formation after immediate breast reconstruction with the extended latissimus dorsi flap: a statistical analysis of 120 consecutive cases.Ann Plast Surg2012;69:145-7

[53] Munhoz AM,Arruda EG,Gemperli R.Management of giant inferior triangle lumbar hernia (Petit’s triangle hernia): a rare complication following delayed breast reconstruction with extended latissimus dorsi myocutaneous flap.Int J Surg Case Rep2014;5:319-23 PMCID:PMC4066570

[54] Casella D,Lo Torto F.Extended latissimus dorsi kite flap (ELD-K Flap): revisiting an old place for a total autologous breast reconstruction in patients with medium to large breasts.Aesthetic Plast Surg2021;45:390-401

[55] Chang DW,Cha S.Autologous breast reconstruction with the extended latissimus dorsi flap.Plast Reconstr Surg2002;110:751-9; discussion 760

[56] Economides JM.Latissimus dorsi and immediate fat transfer (LIFT) for complete autologous breast reconstruction.Plast Reconstr Surg Glob Open2018;6:e1656 PMCID:PMC5811306

[57] Papa G,Renzi N.Protocol for prevention and monitoring of surgical site infections in implant-based breast reconstruction: preliminary results.Medicina (Kaunas)2021;57:151 PMCID:PMC7915384

[58] di Pompeo F, Laporta R, Sorotos M, Pagnoni M, Falesiedi F, Longo B. Latissimus dorsi flap for total autologous immediate breast reconstruction without implants.Plast Reconstr Surg2014;134:871e-9e

[59] Maione L,Vinci V.Fat graft in composite breast augmentation with round implants: a new concept for breast reshaping.Aesthetic Plast Surg2018;42:1465-71

[60] Winkler NS,Kwok AC,Fajardo LL.Autologous fat grafting to the breast: an educational review.J Breast Imaging2022;4:209-21

[61] Escandón JM,Christiano JG.Simultaneous fat grafting during tissue expander-to-implant exchange: a propensity score-matched analysis.Aesthetic Plast Surg2022;Epub ahead of print:

[62] Mushin OP,Langstein HN.Indications and controversies for complete and implant-enhanced latissimus dorsi breast reconstructions.Clin Plast Surg2018;45:75-81

[63] Couto-González I,Brea-García B.Safety of large-volume immediate fat grafting for latissimus dorsi-only breast reconstruction: results and related complications in 95 consecutive cases.Aesthetic Plast Surg2021;45:64-75

[64] Delay E.The role of fat grafting in breast reconstruction.Clin Plast Surg2015;42:315-23, vii

[65] Fayanju OM,Karuturi MS,Bedrosian I.Surgical procedures for advanced local and regional malignancies of the breast. In: Kirby I. Bland, dward M. Copeland, editors. The Breast: Elsevier;2018.p.778-801. e4.

[66] Lin JY,Pu LL.Can we standardize the techniques for fat grafting?.Clin Plast Surg2015;42:199-208

[67] Coleman SR.Long-term survival of fat transplants: controlled demonstrations.Aesthetic Plast Surg1995;19:421-5

[68] Coleman SR.Structural fat grafting.Aesthet Surg J1998;18:386, 388

[69] Lesniak DM,Meredith I.Fat grafting before delayed prophylactic mastectomy and immediate implant reconstruction for patients at high risk of complications.Plast Reconstr Surg2022;149:52-6

[70] Simonacci F,Grieco MP,Raposio E.Procedure, applications, and outcomes of autologous fat grafting.Ann Med Surg (Lond)2017;20:49-60 PMCID:PMC5491488

[71] Khouri RK,Cardoso E,Biggs TM.Megavolume autologous fat transfer: part I. Theory and principles.Plast Reconstr Surg2014;133:550-7

[72] Khouri RK,Khouri RK,Cardoso E.Total breast reconstruction with autologous fat transfer: review of a seven-year multicenter experience.Plast Reconstr Surg2014;134:84-5

[73] Abboud MH,Abboud NM.Power-assisted liposuction and lipofilling: techniques and experience in large-volume fat grafting.Aesthet Surg J2020;40:180-90

[74] Pagliara D,Mangialardi ML.The role of fat grafting on contracted breast implant capsules: a retrospective comparative histological and immunohistochemical study.J Plast Reconstr Aesthet Surg2022;75:1083-93

[75] Coleman SR.Fat grafting to the breast revisited: safety and efficacy.Plast Reconstr Surg2007;119:775-85; discussion 786

[76] Saint-Cyr M,Colohan S.The role of fat grafting in reconstructive and cosmetic breast surgery: a review of the literature.J Reconstr Microsurg2012;28:99-110

[77] Brown AWW,Sherman KA,French JR.Patient reported outcomes of autologous fat grafting after breast cancer surgery.Breast2017;35:14-20

[78] Qureshi AA,Parikh RP,Tenenbaum MM.Patient-reported outcomes of aesthetics and satisfaction in immediate breast reconstruction after nipple-sparing mastectomy with implants and fat grafting.Aesthet Surg J2017;37:999-1008

[79] Bayram Y,Karakol P,Filinte GT.The use of autologous fat grafts in breast surgery: a literature review.Arch Plast Surg2019;46:498-510 PMCID:PMC6882697

[80] Delay E,Guerid S.Indications and controversies in total breast reconstruction with lipomodeling.Clin Plast Surg2018;45:111-7

[81] Hanson SE,Hwang RF.Autologous fat grafting in breast reconstruction: implications for follow-up and surveillance.Gland Surg2021;10:487-93 PMCID:PMC7882329

[82] Ribuffo D,Guerra M.Treatment of irradiated expanders: protective lipofilling allows immediate prosthetic breast reconstruction in the setting of postoperative radiotherapy.Aesthetic Plast Surg2013;37:1146-52

[83] Uda H,Sarukawa S.Brava and autologous fat grafting for breast reconstruction after cancer surgery.Plast Reconstr Surg2014;133:203-13

[84] Khouri R.Breast reconstruction and augmentation using pre-expansion and autologous fat transplantation.Clin Plast Surg2009;36:269-80, viii

[85] Ross RJ,Mutimer KL.Autologous fat grafting: current state of the art and critical review.Ann Plast Surg2014;73:352-7

[86] Dewael S,Fabré G.Immediate versus delayed autologous breast reconstruction: a retrospective matched cohort study of irradiated patients.J Plast Reconstr Aesthet Surg2019;72:1769-75

[87] Lisa AVE,Maione L.Autologous fat grafting efficacy in treating PostMastectomy pain syndrome: A prospective multicenter trial of two Senonetwork Italia breast centers.Breast J2020;26:1652-8

[88] Ercan A,Suleymanov S,Konukoglu D.Effects of Cigarette Smoke on Fat Graft Survival in an Experimental Rat Model.Aesthetic Plast Surg2019;43:815-25

[89] Gornitsky J,Alnaif N,Gilardino MS.A systematic review of the effectiveness and complications of fat grafting in the facial region.JPRAS Open2019;19:87-97 PMCID:PMC7061561

[90] Ørholt M,Hemmingsen MN.Complications after breast augmentation with fat grafting: a systematic review.Plast Reconstr Surg2020;145:530e-7e

[91] Laloze J,Gilhodes J.Cell-assisted lipotransfer: friend or foe in fat grafting?.J Tissue Eng Regen Med2018;12:e1237-50

[92] Vyas KS,Burns JC.Autologous fat grafting does not increase risk of oncologic recurrence in the reconstructed breast.Ann Plast Surg2020;84:S405-10

[93] Wu ZY,Kim HJ.Breast cancer outcomes following immediate breast reconstruction with implants versus autologous flaps: a propensity score-matched study.Breast Cancer Res Treat2022;191:365-73

[94] Eriksen C,Wickman M,Krawiec K.Immediate reconstruction with implants in women with invasive breast cancer does not affect oncological safety in a matched cohort study.Breast Cancer Res Treat2011;127:439-46

[95] Nava MB,Rocco N.Hybrid breast reconstruction.Minerva Chir2018;73:329-33

[96] Senkus E,Ohno S.ESMO Guidelines CommitteePrimary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol2015;26 Suppl 5:v8-30

[97] Alhamad S,El Fakir EH,Tourasse C.Breast implant-associated anaplastic large cell lymphoma. Case report of an undiagnosed form, management and reconstruction (ALCL).Ann Chir Plast Esthet61:223-30

[98] Lamaris GA,Deva AK.Breast reconstruction following breast implant-associated anaplastic large cell lymphoma.Plast Reconstr Surg2019;143:51S-8S

[99] Petit JY,Rotmensz N.Oncological results of immediate breast reconstruction: long term follow-up of a large series at a single institution.Breast Cancer Res Treat2008;112:545-9

[100] Claro F Jr,Zampar AG.Applicability and safety of autologous fat for reconstruction of the breast.Br J Surg2012;99:768-80

[101] Veber M,Toussoun G,Mojallal A.Radiographic findings after breast augmentation by autologous fat transfer.Plast Reconstr Surg2011;127:1289-99

[102] Groen JW,Twisk DJWR.Autologous fat grafting in onco-plastic breast reconstruction: a systematic review on oncological and radiological safety, complications, volume retention and patient/surgeon satisfaction.J Plast Reconstr Aesthet Surg2016;69:742-64

[103] Turnhout AA,Lisabeth-Broné K,van der Sluis WB.Surgical outcome and cosmetic results of autologous fat grafting after breast conserving surgery and radiotherapy for breast cancer: a retrospective cohort study of 222 fat grafting sessions in 109 patients.Aesthetic Plast Surg2017;41:1334-41

[104] Caviggioli F,Klinger F,Klinger M.Autologous fat grafting reduces pain in irradiated breast: a review of our experience.Stem Cells Int2016;2016:2527349 PMCID:PMC4709779

[105] Juhl AA,Damsgaard TE.Fat grafting for alleviating persistent pain after breast cancer treatment: A randomized controlled trial.J Plast Reconstr Aesthet Surg2016;69:1192-202

[106] Jung BF,Oaklander AL.Neuropathic pain following breast cancer surgery: proposed classification and research update.Pain2003;104:1-13

[107] Waltho D.Post-breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach - a review of the literature and discussion.Can J Surg2016;59:342-50 PMCID:PMC5042722

[108] Chappell AG,Yuksel S.Post-mastectomy pain syndrome: defining perioperative etiologies to guide new methods of prevention for plastic surgeons.World J Plast Surg2020;9:247-53 PMCID:PMC7734930

[109] Larsson IM,Bille C.The post-mastectomy pain syndrome-a systematic review of the treatment modalities.Breast J2017;23:338-43

[110] Krastev TK,Hommes J,van der Hulst RRWJ.Autologous fat transfer to treat fibrosis and scar-related conditions: a systematic review and meta-analysis.J Plast Reconstr Aesthet Surg2020;73:2033-48

[111] Caviggioli F,Forcellini D,Klinger M.Autologous fat graft in postmastectomy pain syndrome.Plast Reconstr Surg2011;128:349-52

[112] Maione L,Caviggioli F.Autologous fat graft in postmastectomy pain syndrome following breast conservative surgery and radiotherapy.Aesthetic Plast Surg2014;38:528-32

[113] Sollie M,Bille C,Sørensen JA.Reply: autologous fat grafting as treatment of postmastectomy pain syndrome: a randomized controlled trial.Plast Reconstr Surg2023;151:521e-2e

[114] Wang S,Rubin JP.Molecular mechanisms of adipose tissue survival during severe hypoxia: implications for autologous fat graft performance.Plast Reconstr Surg Glob Open2019;7:e2275 PMCID:PMC6635216

[115] Yang X,Jones T.Comparison of adipose particle size on autologous fat graft retention in a rodent model.Plast Aesthet Res2020;7:8

[116] Ma J,Lin Y.Hepatocyte growth factor secreted from human adipose-derived stem cells inhibits fibrosis in hypertrophic scar fibroblasts.Curr Mol Med2020;20:558-71

[117] Aladari N,Trofin A.Reducing capsular contracture formation in breast augmentation with silicone implants: experimental study on rats.Applied Sciences2022;12:4056

[118] Komorowska-Timek E,Adams NS,Davis AT.Peri-prosthetic fat grafting decreases collagen content, density, and fiber alignment of implant capsules.Plast Reconstr Surg Glob Open2021;9:e3687 PMCID:PMC8751766

[119] Shukla L,Ritchie ME.Therapeutic reversal of radiotherapy injury to pro-fibrotic dysfunctional fibroblasts in vitro using adipose-derived stem cells.Plast Reconstr Surg Glob Open2020;8:e2706 PMCID:PMC7253248

[120] Cogliandro A,Tenna S,Persichetti P.The role of lipofilling after breast reconstruction: evaluation of outcomes and patient satisfaction with BREAST-Q.Aesthetic Plast Surg2017;41:1325-31

[121] Papadopoulos S,Neid M.Using fat grafting to treat breast implant capsular contracture.Plast Reconstr Surg Glob Open2018;6:e1969 PMCID:PMC6414133

[122] Jeong TK,Min KH.Treatment of capsular contracture after breast augmentation with serial fat grafting and implantation.Arch Aesthetic Plast Surg2018;24:68-71

[123] Magill LJ,Jell G,Keshtgar M.Determining the outcomes of post-mastectomy radiation therapy delivered to the definitive implant in patients undergoing one- and two-stage implant-based breast reconstruction: a systematic review and meta-analysis.J Plast Reconstr Aesthet Surg2017;70:1329-35

[124] Olinger TA,Qi J.Outcomes of immediate implant-based mastectomy reconstruction in women with previous breast radiotherapy.Plast Reconstr Surg2020;145:1029e-36e

[125] Panettiere P,Accorsi D.The serial free fat transfer in irradiated prosthetic breast reconstructions.Aesthetic Plast Surg2009;33:695-700

[126] Serra-Renom JM,Serra-Mestre JM.Fat grafting in postmastectomy breast reconstruction with expanders and prostheses in patients who have received radiotherapy: formation of new subcutaneous tissue.Plast Reconstr Surg2010;125:12-8

[127] Salgarello M,Barone-Adesi L.Fat grafting and breast reconstruction with implant: another option for irradiated breast cancer patients.Plast Reconstr Surg2012;129:317-29

[128] Komorowska-Timek E,Davis AT.Outcomes of prosthetic reconstruction of irradiated and nonirradiated breasts with fat grafting.Plast Reconstr Surg2017;139:1e-9e

[129] Haran O,Tiosano A.Postirradiation capsular contracture in implant-based breast reconstruction: management and outcome.Plast Reconstr Surg2021;147:11-9

[130] Calabrese S,De Francesco F.Long-term impact of lipofilling in hybrid breast reconstruction: retrospective analysis of two cohorts.Eur J Plast Surg2020;43:257-68

[131] Martin S,Beniwal A,Lee G.Autologous fat grafting and the occurrence of radiation-induced capsular contracture.Ann Plast Surg2021;86:S414-7

[132] Ma H,Lin C,Tsai C.Facial recontouring with autologous cryopreserved fat graft.Formos J Surg2018;51:58-62

[133] Erol OO.Facial rejuvenation with staged injections of cryopreserved fat and tissue cocktail: clinical outcomes in the past 10 years.Aesthet Surg J2013;33:639-53

[134] Moscatiello F,Grella R.Gluteal augmentation with cryopreserved fat.Aesthet Surg J2010;30:211-6

[135] Mashiko T,Kanayama K.Biological properties and therapeutic value of cryopreserved fat tissue.Plast Reconstr Surg2018;141:104-15

[136] Kim SK,Hwang K.Mixed infection of an atypical Mycobacterium and Aspergillus following a cryopreserved fat graft to a face.J Craniofac Surg2013;24:1676-8

[137] Kølle SF,Mathiasen AB.Enrichment of autologous fat grafts with ex-vivo expanded adipose tissue-derived stem cells for graft survival: a randomised placebo-controlled trial.Lancet2013;382:1113-20

[138] Kølle ST,Taudorf M.Ex vivo-expanded autologous adipose tissue-derived stromal cells ensure enhanced fat graft retention in breast augmentation: a randomized controlled clinical trial.Stem Cells Transl Med2020;9:1277-86 PMCID:PMC7581442

[139] Gentile P,Bocchini I.Breast reconstruction with autologous fat graft mixed with platelet-rich plasma.Surg Innov2013;20:370-6

[140] Kamakura T.Autologous cell-enriched fat grafting for breast augmentation.Aesthetic Plast Surg2011;35:1022-30

[141] Tissiani LA.A prospective and controlled clinical trial on stromal vascular fraction enriched fat grafts in secondary breast reconstruction.Stem Cells Int2016;2016:2636454 PMCID:PMC4707337

[142] Chen A,Chen P,Tang S.Comparison of the efficacy and safety of cell-assisted lipotransfer and platelet-rich plasma assisted lipotransfer: what should we expect from a systematic review with meta-analysis?.Cell Transplant2021;30:963689721989607 PMCID:PMC8058798

[143] Pérez-Cano R,Lasso JM.Prospective trial of adipose-derived regenerative cell (ADRC)-enriched fat grafting for partial mastectomy defects: the RESTORE-2 trial.Eur J Surg Oncol2012;38:382-9

[144] Moloughney JG.Poloxamer 188 (p188) as a membrane resealing reagent in biomedical applications.Recent Pat Biotechnol2012;6:200-11 PMCID:PMC3756676