Autologous fat grafting and injectable fillers for post-reconstructive breast remodelling: A systematic review and quantitative synthesis

Breast remodelling after reconstructive surgery often requires secondary volume restoration and contour refinement. Autologous fat grafting (AFG) is widely used, whereas injectable body fillers are used in selected cases despite concerns regarding durability and late complications. We performed a systematic review with quantitative synthesis of available outcome data on post-reconstructive breast remodelling using AFG and injectable fillers. PubMed/MEDLINE, Embase (Ovid), Cochrane CENTRAL, and Scopus were searched from inception to October 2025. The review protocol was prospectively registered in PROSPERO (CRD420251113092). Primary clinical studies reporting outcomes after reconstructive breast remodelling with AFG and/or injectable fillers were included; systematic reviews were screened for reference identification but were not included as primary studies. Where clinical and methodological heterogeneity allowed, quantitative synthesis was performed using random-effects models in Review Manager (RevMan) 5.4. Heterogeneity thresholds were predefined using the I² statistic, and publication-bias analyses were limited to outcomes with sufficient study numbers. Twenty-three primary studies met inclusion criteria. For AFG, pooled 12-month volume retention was 63.7% (95% CI 58.4-69.0; random-effects model; I² = 42%), with pooled retention of 56.2% (95% CI 51.1-61.3) at 24 months. Filler studies generally reported lower 12-month durability (approximately 31-45%), but were heterogeneous in product type, definitions, and follow-up, limiting formal pooling. Across reporting studies, AFG generally showed favourable aesthetic and patient-reported outcomes, while permanent and semi-permanent fillers were more frequently associated with clinically significant late complications including migration, chronic inflammatory reactions and secondary intervention. Current evidence supports AFG as a well-established option for post-reconstructive breast remodelling in appropriately selected patients, whereas evidence for permanent and semi-permanent fillers remains limited and heterogeneous due to less favourable risk-benefit profiles.