Systematic review: Oncological safety of reconstruction with fat grafting in breast cancer outcomes

Background: Autologous fat grafting (AFG) has become a commonly used procedure for breast reconstruction (BR) after cancer removal. Nevertheless, oncological considerations remain for AFG after breast cancer surgery.Objectives: This article aims to evaluate the oncological safety of AFG in BR and its effect on disease-free survival (DFS) and local-regional recurrences (LRR).Methods: A systematic review regarding the use of AFG in BR to identify a difference in in-cidence rates of LRR and DFS between patients who had AFG and controls was performed us-ing PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Sco-pus, and Cochrane databases. The protocol was developed following the Preferred Reporting for Items for Systematic Reviews-Protocols (PRISMA-P) guidelines. The included studies had to match predetermined criteria according to the PICOS approach.Results: A total of 11 studies were included. Seven studies reported LRR, and 5 studies re-ported DFS in 5,886 patients. Our systematic review showed that AFG was not associated with increased LRR and DFS. Pooled hazard ratios (HRs) (95% confidence intervals [CIs]) for LRR and DFS were 1.26 (0.90-1.76) and 1.27 (0.96-1.69), respectively.Conclusions: AFG can, therefore, be performed safely in BR after breast cancer. Further, ran-domized controlled trials and related systematic reviews, as well as evidence-based medicine(EBM) studies of level 1, are required to consolidate the results of the studies identified in this systematic review.(c) 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by El-sevier Ltd. All rights reserved.