Risks of autologous fat grafting
Fat grafting does carry a risk of intra-luminal injection causing necrosis and infarct of the end organ tissue, which in the head and neck can be devastating and there are numerous reports of blindness, facial skin loss, fat embolic syndrome and cerebral infarct (37-39).
Donnenberg et al suggested that ASCs support growth in active breast cancer cells. In the conclusion of their xenograft study, AFG in breast reconstruction should be deferred until cancer remission is confirmed. However, fat grafting and ASCs have not been shown to drive cancer growth in clinical reality, several studies with big cohorts showed no evidence for an elevation in oncological risk in AFG (40-42).
Silva et al found no evidence for clinically relevant elevations in tumour size, proliferation, histologic grade or metastasis in AFG breast reconstruction in an animal model (43). Moreover, Mazur et al found no indication for a higher breast cancer risk in ASCs augmented fat in post-cancer mastectomy and radiation patients (44).
This is sometimes a result of graft retention or simple distribution over time within the surrounding tissue. Retention rates, however, stay the same in repeated injections (45). Bourne et al found that retention rates differed in smokers, who had greater volume retention over predictable 9 months (45). Further, the study group stated that AFG is less invasive and therefore safer than conventional reconstruction options (45).
The evidence overall is lacking, and there is no specific research respectively addressing the oncologic risk profile of AFG in the head, face and neck. Some publications concentrated on the general complications of AFG in the head, face and neck, and stated a low rate of minor complications (5, 46, 47). Karmali et al, in their publication, investigating outcomes of AFG for head and neck reconstruction and found no evidence for an association with cancer recurrence (48).