Background: Breast augmentation with fat grafting is used as an alternative to breast implants. However, a systematic evaluation of the complication rates after fat grafting using only studies with consecutive patients has not previously been performed. In this study, the authors compiled studies reporting complication rates and radiologic changes in consecutive patients undergoing cosmetic breast augmentation with fat grafting. Methods: Studies reporting on consecutive patients undergoing breast augmentation with fat grafting were included. Complication rates, radiologic changes, Breast Imaging Reporting and Data System assessments, and the number of patients undergoing revision surgery were extracted. Mean complication rates and radiologic changes were calculated with meta-analytical methods. Results: Twenty-two studies with 2073 patients were included. The rates of major complications were low (hematoma, 0.5 percent; infection, 0.6 percent; and seroma, 0.1 percent). None of these patients needed revision surgery. The most frequent minor complication was palpable cysts in 2.0 percent of the patients; 67 percent of these were treated with aspiration. The radiologic changes in the patients after fat grafting were as follows: oil cysts, 6.5 percent; calcifications, 4.5 percent; and fat necrosis, 1.2 percent. The risk of being referred for additional radiologic imaging (e.g., to exclude malignant changes) was 16.4 percent, and the risk of being referred for biopsy was 3.2 percent. Conclusions: The complication rates after breast augmentation with fat grafting are low and support fat grafting as an alternative to breast augmentation with implants. The rates of radiologic changes are high after fat grafting, but the changes do not seem to have any therapeutic consequences for the patients.

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he need for anatomical implants for breast augmentation surgery has been widely debated. [1][2][3] Anatomical breast implants can provide surgeons with a wider range of options to tailor breast augmentation to the dimensions of the individual patient. In our experience, they are especially valuable for women with glandular ptosis who prefer to avoid augmentation-mastopexy. 1,4 However, anatomical implants have an inherent risk of rotation malposition, which is not an issue with round implants, and for this reason, many surgeons are reluctant to use them. 5,6 Previous studies reported a 1.1 percent to 14 percent incidence of implant rotation. 4,[6][7][8][9] However, the majority of these studies 4,7,8,10 were performed with macrotextured implants (e.g., Allergan/McGhan), which are proposed to be less inclined to rotate than microtextured implants because macrotextured implants adhere to the capsule. 11,12 With Allergan's recent retraction of Biocell implants due to their suspected relationship to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), more data are needed on the risk of rotation with microtextured anatomical implants. 13 In this study, we investigated consecutive patients who underwent breast augmentation or implant exchange with Mentor's microtextured anatomical implants. Furthermore, we present