Oncologic Safety and Viability of Stem Cell-Enriched Autologous Fat Grafting: A Narrative Review of the Preclinical and Clinical Evidence
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Abstract
Autologous fat grafting has become a cornerstone of both reconstructive and aesthetic plastic surgery, yet unpredictable resorption of the transplanted tissue remains its principal technical limitation. This has driven the development of enrichment strategies in which the lipoaspirate is supplemented with the stromal vascular fraction or with culture-expanded adipose-derived stem/stromal cells (ADSCs). Enrichment consistently improves graft retention in most clinical series, but ADSCs are also potent secretors of angiogenic, mitogenic and immunomodulatory mediators, which raises a legitimate concern: could the same biology that keeps a graft alive also awaken or accelerate residual tumor cells in the recipient bed? This narrative review synthesizes the current in vitro, animal and clinical evidence on the oncologic safety and technical viability of stem cell-enriched fat transfer, with emphasis on breast reconstruction after oncologic surgery. Laboratory studies remain frankly contradictory, describing both tumor-promoting and tumor-suppressive effects that appear to depend on the donor, the cell subpopulation, the tumor molecular subtype and the experimental model. In vivo animal work is similarly divided, although several models suggest that whole fat graft is a less permissive environment for tumor engraftment than the isolated cell fraction. In contrast, clinical series, matched cohorts and multicenter studies including several thousand patients have not demonstrated an increase in locoregional recurrence, systemic recurrence or second primary tumors attributable to either conventional or enriched fat grafting. The available evidence supports the continued use of enriched lipotransfer in patients who have completed oncologic treatment and show no evidence of active disease, provided that informed consent, structured imaging follow-up and prospective data collection are incorporated into routine practice.
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