The mainstream approaches for breast reconstruction include one-stage or two-stage methods such as autologous flap transplant or tissue expander/breast implant placement. Autologous fat transfer is also a viable option. However, breast cancer patients tend to be slimmer, which makes obtaining fat more difficult. Moreover, fibrosis induced by radiation therapy would significantly reduce the injection amount and survival rate of fat cells. Thus, only a small population of breast cancer patients is suitable for breast reconstruction using autologous fat transfer. In addition, the skin on the side of mastectomy tends to present with scar adhesion or circulation problems due to previous surgeries. The success rate of using autologous fat alone would be much lower than that in the normal population. The injection amount is limited by the skin condition, making the long-term maintenance of the results more difficult. Patients may need to undergo multiple or phased fat injections to achieve more apparent augmentation results. Recently, some doctors used a BRAVA vacuum device on the affected side of the breast to increase skin elasticity and circulation, which makes the skin expand more for large volume fat injection, but the long-term result is still unverified.
Due to the many limitations presented above, breast reconstruction with autologous fat transfer has not gained popularity and is mostly used as a supplement to other reconstruction surgeries. For example, those with inadequate conditions for autologous fat transfer can consider reconstruction with breast implants first and then use autologous fat to adjust breast shape or fullness. A more recent method involves implant placement along with partial autologous fat injection to increase naturalness and symmetry (hybrid augmentation). The surgery could also simultaneously increase the texture of implants and reduce the chance of presence of implant edges or wrinkles.