Adipose-Derived Stem Cell–Enriched Fat Grafting for Breast Reconstruction: A Systematic Review of Efficacy and Oncological Safety
Francesca Maria Scura, Elisa Bertulla, Edoardo RaposioBackground
Autologous fat grafting is increasingly used for breast reconstruction, but unpredictable resorption (retention 25–80%) limits its utility. Enrichment with adipose-derived stem cells (ADSCs) or the stromal vascular fraction (SVF), termed cell-assisted lipotransfer (CAL), has been proposed to improve graft survival.
Objectives
This systematic review evaluates the efficacy and oncological safety of ADSC/SVF-enriched fat grafting for breast reconstruction and augmentation.
Design
Systematic review without meta-analysis, reported in accordance with PRISMA 2020.
Data Sources and Methods
PubMed MEDLINE, Scopus and the Cochrane Library were searched combining terms for adipose-derived stem cells, stromal vascular fraction, cell-assisted lipotransfer, breast reconstruction, breast augmentation, fat grafting and lipofilling. English-language human studies were eligible; nineteen studies were included and analysed qualitatively.
Results
Nineteen studies (randomised trials, comparative cohorts and case series, 2007–2020) were included. A triple-blind RCT of ex vivo–expanded ADSCs showed retention of 80.9% versus 16.3% (p < 0.0001); a subsequent RCT reported 80.2% versus 45.1%. Pooled analyses confirmed a mean retention benefit of approximately 27%, with the largest gains for expanded ADSCs and more modest gains for SVF-based methods. One prospective study found no significant advantage of SVF enrichment (74% versus 79%). Complication rates were comparable between enriched and conventional grafts. No consistent increase in locoregional recurrence was observed, except in patients with intraepithelial neoplasia.
Conclusion
ADSC/SVF-enriched fat grafting can improve graft retention, with ex vivo–expanded ADSCs yielding the most consistent benefit. The evidence is heterogeneous; standardisation of cell-isolation methods, outcome reporting and long-term oncological surveillance is required before routine adoption.