Table 1. In vivo detailed studies assessment.
| Author, year | Design | Sample | Outcomes | Key findings |
|---|---|---|---|---|
| Berti, 2022, (29) | Retrospective, monocentric, case-control study | 412 women, with 109 (26.5%) in the lipofilling group and 303 in the non-lipofilling group | In the overall study population, lipofilling did not show predictive significance for recurrence (HR =1.39, P=0.41), overall survival (HR =0.84, P=0.79), or distant metastases (HR =1.10, P=0.84) | In women treated for invasive cancer, the multivariate analysis indicated that lipofilling was an independent predictive factor for local recurrence (HR =5.06, P=0.04) |
| Mazur, 2018, (30) | The study investigated tumor recurrence in patients with autologous ADSC breast reconstruction vs. those without reconstruction over a 3-year observation period | 56 reconstructed + SVF AFG vs. 252 without subsequent reconstruction | Cancer recurrence in patients treated with ASC-enriched fat for breast reconstruction was 3.7%, comparable to the control group (4.13%), with no observed adverse effects of therapy | Suggests safety of using ASC-enriched fat for breast reconstruction in terms of cancer recurrence |
| Toyserkani, 2017, (31) | Open-label, single-arm, single-center feasibility and safety study in patients with breast cancer-related lymphedema of the upper extremity | 11 patients | Arm heaviness reduced from a baseline median score of 5.5 to 2.5 after 6 months (P=0.0030). Arm tension decreased from a baseline median of 5.0 to 2.5 after 6 months (P=0.0097). DASH score improved from 21.3 at baseline to 12.9 after 6 months (P=0.0168) | Autologous ADRC with scar-releasing fat graft proved safe over 6 months, effectively alleviating breast cancer-related lymphedema symptoms and reducing the need for conservative treatment |
| Myckatyn. 2017, (32) | Mastectomy with immediate breast reconstruction between 2006 and 2011, age older than 21 years, female sex, and incident diagnosis of invasive ductal carcinoma (stage I, II, or III) | n=1,197, consisted of all recurrences during the study period (n=225) and a 30% random sample of the study population (n=972) | The HR for disease recurrence with fat transfer was 0.99 (95% CI: 0.56–1.7), and after adjustment, it remained at 0.97 (95% CI: 0.54–1.8) | In breast cancer patients who had mastectomy with immediate reconstruction, no association with a higher risk of cancer recurrence |
| Vester-Glowinski, 2022, (33) | Double-blind, randomized controlled trial of breast augmentation with ASC-enriched fat grafting | 20 women | After 1 year, ADSC-enriched fat grafts (54.0%, 95% CI: 30.4–77.6%) and placebo-enriched fat grafts (55.9%, 95% CI: 28.9–82.9%) demonstrated comparable volume retention in breasts (P=0.566, n=10 each) |
Both groups had similar volume retention |
| Kempa, 2022, (34) | Monocentric cohort from all consecutive patients who underwent AFG after breast cancer from 2008 to 2020 | 93 women | The study showed low rates of local recurrence (1.1%), distant metastases (2.2%), and tumor-related death (1.1%), with 67.12% of patients expressing satisfaction with autologous fat grafting | Study aligns with the literature, showing a consistent low incidence of tumor recurrence and metastasis following AFG use |
| Calabrese, 2018, (35) | Long-term cancer recurrence risk of SVF + AFT compared to AFT, after nipple sparing mastectomy | 41 women G1 (SVF + AFT), 64 G2 (AFT), and 64 G3 (control group) |
Loco-regional recurrence rates were 2.4%, 4.7%, and 1.6% for G1, G2, and G3, while systemic recurrence rates were 7.3%, 3.1%, and 3.1%, respectively | No significant risk factors for loco-regional or systemic recurrence were identified among the variables, including SVF + AFT (G1) which showed no increase in oncological recurrence |
| Ito, 2017, (36) | Female breast cancer patients who underwent breast-conserving surgery and adjuvant radiotherapy. They received an autologous fat graft enriched with ADRC during adipose tissue harvest | n=10 | Operation time: 188±30 min. Hospitalization: 1.2±0.4 days. No complications. No recurrence/metastasis in 7.8±1.5 years post-transplantation | ADRC-enriched autologous fat transplantation is safe without long-term recurrence and, a viable option for breast reconstruction, even following adjuvant radiotherapy |
| Kølle, 2013, (37) | Randomized, controlled, data assessor-blinded clinical trial. Participants undergoing breast augmentation | n=16, 8 each group | ASC-enriched fat grafts demonstrated significantly higher retention rates (mean =80.2%) compared to conventional fat grafts (mean =45.1%) | Potential use of ADSCs for both reconstructive and cosmetic volume restoration, presenting an attractive alternative to conventional fat grafting and implants |
| Intervention group: ASC-enriched fat grafts | Clinical photos showed statistically superior results in the intervention group, as assessed by independent clinical experts | |||
| Control group: conventional nonenriched fat grafts | ||||
| Gentile, 2013, (38) | Comparison of fat grafting with PRP to a control group using only centrifuged fat grafting | 50 patients treated with fat grafting + PRP and a control group of 50 patients treated with centrifuged fat grafting | Patients treated with PRP added to autologous fat grafts showed a 69% maintenance of contour restoration and 3-dimensional volume after 1 year | PRP + fat grafting leads to a significant improvement in maintaining breast volume in patients with breast soft-tissue defects compared to centrifuged fat grafting alone |
| The control group treated with centrifuged fat grafting showed a 39% maintenance | ||||
| Chiu, 2019, (39) | SVF-enriched fat grafting vs. conventional fat grafting | 105 patients controls; 101 SVF-AFG | Survival rate of transplanted fat at 12 months: 67.9% in group A, 68.7% in group B | Study does not support the use of SVF in autologous fat grafting for breast augmentation |
| Postoperative complication rate: 3.8% in group A, 5.9% in group B | ||||
| Statistically insignificant differences observed between the two groups | ||||
| Hu, 2022, (40) | Breast augmentation with autologous fat transplantation alone compared to cell-assisted autologous fat transplantation, randomized | n=34, 17 each | The observation group had higher CC, SN-N, and N-MF, a statistically significant higher uplift value after surgery and MRI revealed greater postoperative fat retention compared to the control group | Suggested superiority of cell-assisted AFG compared to AFG alone |
| Salgarello, 2011, (41) | 10% PRP + AFG vs. Coleman fat grafting | 17 patients (40%) received fat enriched with 10% PRP (group A), while 25 patients (60%) received only Coleman fat grafts (group B) | 10% PRP was not superior to Coleman fat grafting alone | The retrospective analysis does not show effect of 10% PRP on fat graft take compared to Coleman fat grafting |
| Kronowitz, 2016, (42) | Mastectomy for breast cancer or risk reduction and subsequent breast reconstruction with or without lipofilling | 719 breasts for lipofilling group, 305 risk reduction, and 670 no-lipofilling | Locoregional recurrence rates at 5 years were 1.6% for cases (lipofilling) and 4.1% for controls (no lipofilling) | Supports the oncologic safety of lipofilling in breast reconstruction, as there was no increase in locoregional recurrence, systemic recurrence, or second breast cancer |
| Systemic recurrence rates were 2.4% for cases and 3.6% for controls | ||||
| Tukiama, 2021, (43) | Retrospective matched cohort. 1:3 | 42 patients treated for breast cancer who underwent AFG vs. control: 126 patients without AFG | Locoregional recurrence (7.1% vs. 6.3%; P=0.856) | No evidence of increased risk in any of the survival outcomes, suggesting that lipofilling is a safe procedure for breast reconstruction after surgical treatment of breast cancer |
| Local recurrence (7.1% vs. 5.6%; P=0.705) | ||||
| Distant recurrence (14.3% vs. 7.9%; P=0.238) | ||||
| Disease-free survival (21.4% vs. 19.0%; P=0.837) | ||||
| Overall survival (14.3% vs. 7.1%; P=0.181) | ||||
| Juhl, 2018, (44) | Prospective, AFG reconstruction after breast conserving surgery | 42 patients undergoing 1–3 AFG procedures | Calcifications: 21%; oil cysts: 85%; increased scarring: 3% | Considerable radiologic breast imaging changes induced by AFG after breast conserving surgery |
| Serra-Mestre, 2017, (45) | Fat grafting to reduce asymmetry in breast reconstruction, mastopexy, and augmentation | 86 patients | Statistically significant reduction in mean intermammary distance. One capsular contracture in a breast reconstruction requiring capsulotomy and an oil cyst requiring aspiration | Safe remodeling of the medial cleavage of the breast |
| Kaoutzanis, 2016, (46) | Consecutive postmastectomy AFG | 108 women with a total of 167 breast reconstructions | AFG + breast reconstruction resulted in a biopsy rate of 4.8% | Suggests AFG is a relatively safe procedure for refinement of the reconstructed breast in postmastectomy patients |
| No cases of locoregional cancer recurrence | ||||
| Suspicious imaging findings requiring biopsy showed fat necrosis, scar, or oil cysts without evidence of malignancy | ||||
| Gale, 2015, (47) | Case-controlled AFG in women with breast cancer history | 211 participants (invasive carcinoma, n=184; ductal carcinoma in situ, n=27). Control subjects: matched 2:1 | Local recurrence: 0.95% vs. 1.90% (P=0.33) | No evidence of increased oncologic risk associated with fat grafting in women previously treated for breast cancer |
| Regional recurrence: 0.95% vs. 0% (P=0.16) | ||||
| Distant recurrence: 3.32% vs. 2.61% (P=0.65) | ||||
| Klinger, 2022, (48) | Differences in LRR and LRFS were assessed between patients who underwent AFG and those who did not | n=6,592 | LRR was 5.3% in the matched population, 3.9% in the AFG group, and 6.1% in the non-AFG group, suggesting non-inferiority of AFG (P=0.084) | Autologous fat grafting does not negatively interfere with cancer prognosis |
| Kaplan-Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR =0.73, 95% CI: 0.41–1.30, P=0.291) | ||||
| Similar effects in terms of LRFS were observed among different biological subtypes (luminal-like group, HER-2 enriched-like, and TNBC) | ||||
| Yoshimura, 2008, (49) | SVF-AFG for breast augmentation | n=40 | Postoperative atrophy of injected fat was minimal and remained stable after 2 months. Cyst formation or microcalcification was detected in four patients | Effective and safe for soft tissue augmentation and may outperform conventional lipoinjection |
| Almost all patients reported satisfaction with the soft and natural-appearing augmentation | ||||
| Wang, 2015, (50) | SVF-AFG for breast augmentation | n=12 | Fat Resorption was 51.84% (16.74%) at 6 months postoperatively | Little complications using SVF + AFG for breast augmentation |
| Newly formed cysts and nodules in two cases; no calcification in MRI | ||||
| Shin, 2023, (51) | SVF-AFG for breast augmentation | n=384 | Higher SVF cell number associated with greater retention volume. Greater retention volume in patients with soft breasts | Limiting arm movement, increasing SVF cell count, and improving skin tension may enhance retention rates |
| Right breast retention rate (60.35%) lower than left breast (77.48%) at 18 months | ||||
| Jeon, 2021, (52) | SVF-AFG vs. AFG for correcting contour deformities of reconstructed breasts | n=20, 10 each group | Fat graft retention rate: Group 1 vs. Group 2 at 6 months: 73.8% vs. 62.2% (P=0.03); Group 1 vs. Group 2 at 12 months: 65.4% vs. 48.4% (P=0.03) | SVF is effective in increasing survival rates of autologous fat grafts for correcting volume deficit after breast reconstruction |
| Group 1 showed higher satisfaction | ||||
| Fat necrosis occurred in 1 patient in each group | ||||
| No locoregional recurrence during follow-up | ||||
| Pérez-Cano, 2012, (53) | ADSC-AFG for breast conservation therapy contour defects correction | n=71 | No serious adverse events associated with the ADRC-enriched fat graft injection procedure | Suggests safety and efficacy ADSC-AFG for breast conservative therapy contour defects |
| No reported local cancer recurrences. Injection site cysts reported in ten patients |
HR, hazard ratio; ADSC, adipose-derived stem cell; SVF, stromal vascular fraction; AFG, autologous fat grafting; ASC, adipose-derived stromal cell; DASH, Disabilities of the Arm, Shoulder and Hand; ADRC, adipose-derived regenerative cells; CI, confidence interval; AFT, autologous fat transfer; PRP, platelet-rich plasma; CC, chest circumference; SN-N, sternal notch-nipple distance; N-MF, distance between nipple and inframammary fold; MRI, magnetic resonance imaging; LRR, locoregional recurrence rate; LRFS, locoregional recurrence-free survival; aHR, adjusted hazard ratio; TNBC, triple-negative breast cancer.