Autologous fat transfer for complete breast reconstruction in irradiated breast cancer patients: A systematic review

Background: Autologous fat transfer (AFT) has emerged as a minimally invasive alternative for complete breast reconstruction. Its use after radiotherapy (RT) remains controversial owing to concerns regarding graft retention, complications and oncological safety. This systematic review aimed to describe reported outcomes, safety data and patient-and surgeon-reported results of total AFT breast reconstruction in irradiated patients. Methods: A systematic search of the PubMed, Embase and Scopus databases (14 April 2025) was conducted following the PRISMA guidelines. Studies on complete breast reconstruction using AFT in irradiated patients were included. Data extracted included patient demographics, RT parameters, AFT technique, number of sessions, injected volume, complications, recurrence and satisfaction. Risk of bias was assessed using ROBINS-I. Results: Eleven studies encompassing 783 patients were included, with irradiated cohorts ranging from 9 to 54 patients per study. Most reconstructions were delayed after RT, with varying surgical protocols. Mean follow-up ranged from 3 to 86.2 months. The mean number of AFT sessions ranged from 3.2 to 7.6 in irradiated patients. Mean per-session volumes ranged from 109 to 293 mL, with mean cumulative volumes for completed reconstructions varying between 490 and 1109.2 mL. In studies that included irradiated and non-irradiated cohorts, some authors reported higher session counts and/or greater cumulative volumes in irradiated breasts, whereas others observed comparable values between the groups. Most included studies reported minor complications and high satisfaction rates. Recurrence events were infrequently described. Conclusion: This systematic review found that total breast reconstruction using AFT in irradiated patients appears feasible and to be associated with high patient satisfaction and acceptable complication rates. However, the available evidence is predominantly retrospective and heterogeneous. Therefore, conclusions regarding long-term safety and effectiveness should be interpreted cautiously and further prospective studies with standardised reporting are warranted. (c) 2026 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).