REVIEW Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: A systematic review Rene D. Largo a, *, Laurent A.H. Tchang a , Valentina Mele b , Arnaud Scherberich b , Yves Harder c , Reto Wettstein a , Dirk J. Schaefer a a Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland a b Institute for Surgical Research and Hospital Management, University Hospital of Basel, Basel, Switzerland c Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universita¨t Mu¨nchen, Munich, Germany Received 20 April 2013; accepted 24 November 2013 KEYWORDS Lipotransfer; Volume gain; Cosmetic; Oncological risk; Breast augmentation; Breast reconstruction; Systematic review; PRISMA Summary Background: Fat grafting for primary breast augmentation is growing in popularity due to its autologous properties and its side benefit of removing unwanted fat from other areas, although volume gain is unpredictable and patient safety remains unclear. Objective: The aim of this study was to provide an evidence-based overview of autologous fat grafting to healthy breast tissue with focus on volume gain, safety and complications. Design: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Data sources: The MEDLINE, Cochrane Library and EMBASE databases were searched for clinical studies on autologous fat grafting to healthy breast tissue within the last 30 years. Data extraction: Clinical articles were evaluated for indication, pre- and postoperative work- up, surgical technique, volume gain (efficacy), complications, radiographic changes and onco- logical safety. The level of evidence was assessed according to the Oxford Centre for Evidence- based Medicine 2011. * Corresponding author. Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland. Tel.: þ41 61 328 7227; fax: þ41 61 265 7301. E-mail address: rene.largo@usb.ch (R.D. Largo). a Department to which the work should be attributed. + MODEL Please cite this article in press as: Largo RD, et al., Efficacy, safety and complications of autologous fat grafting to healthy breast tissue: A systematic review, Journal of Plastic, Reconstructive & Aesthetic Surgery (2013), http://dx.doi.org/10.1016/j.bjps.2013.11.011 1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.11.011 Journal of Plastic, Reconstructive & Aesthetic Surgery (2013) xx,1e12