Optimal Strategies for Autologous Fat Grafting in Breast Augmentation and Reconstruction: A Systematic Review and Network Meta-Analysis.

Summary

Across 12 studies, both cell-assisted lipotransfer and PRP-assisted lipotransfer demonstrated superior fat survival compared with conventional fat grafting for breast augmentation/reconstruction, without increasing postoperative complications. The analysis supports considering biologically assisted techniques to improve graft retention, while acknowledging the need for standardized protocols and long-term data.

Key Findings

• Network meta-analysis of 12 studies found higher fat survival with CAL and PRP-assisted lipotransfer versus conventional grafting.
• No significant differences in postoperative complication rates among CAL, PRP, and conventional techniques.
• Frequentist random-effects framework implemented in R (netmeta/dmetar) enabled indirect and mixed comparisons.

Clinical Implications

Surgeons may consider CAL or PRP-assisted techniques to enhance fat retention without added complication risk, tailoring selection to resources, regulatory context, and patient-specific factors until standardized protocols and long-term safety are established.

Limitations

• Heterogeneity in harvesting, processing, and outcome measurement across included studies.
• Limited number of high-quality randomized trials and incomplete long-term follow-up.

Future Directions

Conduct adequately powered RCTs with standardized CAL/PRP protocols, core outcome sets for retention and safety, and long-term imaging-based follow-up.