Evaluation of effects of autologous fat grafting on aesthetic outcomes in breast reconstruction following mastectomy: Effects of reconstruction type and prior radiotherapy exposure

Background Autologous fat grafting improves breast reconstruction aesthetics, yet impact relative to natural post-reconstructive changes remains poorly characterized. Methods Retrospective analysis of 92 reconstructions (42 fat-grafted, 50 non-grafted) using BCCT.core and Harvard Scale assessments at 6-12 months. Results Non-grafted reconstructions demonstrated significant deterioration (46%; BCCT.core p=0.027, Harvard p<0.001) uniformly across modalities. Conventional 3-week radiotherapy produced greater deterioration than 5-day regimens (p=0.036, p=0.024). Fat grafting reversed this trajectory, achieving 88.1% versus 4% complete complaint resolution (Mann-Whitney p<0.001; effect sizes 0.41-0.84) across all reconstruction types and radiotherapy exposures. Irradiated reconstructions demonstrated greatest gains. One to two sessions typically sufficed. Conclusion Post-reconstructive deterioration should be anticipated. Fat grafting functions as regenerative intervention modifying biological maturation. Findings support proactive staged incorporation into algorithms, particularly for irradiated patients.