Introduction and aims:
There is growing interest in the potential of autologous fat grafting (AFG) for breast reconstruction. However, concerns remains regarding it ́s effectiveness, safety and intereference with mammography. The possibility of local growth factors and adipose derived stem cells causing cancer recurrence is also a key concern.

Material and Methods:
A protocol was published a priori. All studies investigating AFG for women undergoing reconstruction post mastectomy or breast conserving surgery for treatment of breast cancer were considered. We assessed six domains; Oncological, clinical, aesthetic/functional, patient reported, process and radiological. Electronic databases were searched to June 2013; additional grey literature searches were also performed. Two independent reviewers assessed eligibility of articles for inclusion and performed data extraction.

Results:
31 studies were included (3,521 patients). Current studies have a median follow up of 14.8 months, and a high degree of patient and surgeon satisfaction. Fat necrosis is the commonest complication in 4.4%. Other harms include further radiological investigation (11.5%) and the need for biopsy (2.5%) to exclude malignancy. Restricting to moderate quality studies focusing on in-situ disease, the recurrence rate was 9.4%, compared with 1.6% in matched controls (p=0.03).

Conclusion:
AFG is a potentially useful tool within the armamentarium of those performing breast reconstruction. The need for long-term follow up is underscored by this review. High quality research is required to demonstrate long-term oncological ramifications and to determine the potential for AFG as a total breast reconstruction method.