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Shaaban et al. Plast Aesthet Res 2023;10:12 Plastic and
DOI: 10.20517/2347-9264.2022.91
Aesthetic Research

Review Open Access

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

1
1
1,2
Bahaa Shaaban , David Guerrero , Carolyn De La Cruz , Lauren Kokai 1,3,4
1
Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
2
University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
3
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
4
McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15213, USA.
Correspondence to: Prof. Lauren Kokai, Department of Plastic Surgery, University of Pittsburgh School of Medicine, 1606E
Biomedical Science Tower, 200 Lothrop Street, Pittsburgh, PA 15261, USA. E-mail: kokail@upmc.edu
How to cite this article: Shaaban B, Guerrero D, De La Cruz C, Kokai L. Fat grafting in autologous breast reconstruction:
applications, outcomes, safety, and complications. Plast Aesthet Res 2023;10:12. https://dx.doi.org/10.20517/2347-
9264.2022.91
Received: 10 Aug 2022 First Decision: 11 Jan 2023 Revised: 1 Mar 2023 Accepted: 27 Mar 2023 Published: 3 Apr 2023

Academic Editor: Marten Basta Copy Editor: Ying Han Production Editor: Ying Han

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

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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