Background
Contemporary techniques for breast reconstruction are implant-based reconstruction (IBR) and reconstruction using autologous free tissue flaps. This study investigates a third autologous, yet less invasive technique: autologous fat transfer (AFT). It was compared to the gold-standard IBR. Currently, there is insufficient evidence that AFT is safe and effective.

Methods:
This trial was performed in seven hospitals across the Netherlands. Breast cancer patients opting for breast reconstruction were included. Randomization to AFT or IBR was done in a 1:1 ratio. Primary outcome measure was quality of life (QoL), measured by the BREAST-Q questionnaire, at 12 months after final surgery.

Results
A total of 193 patients were included in this study (91 AFT, 80 IBR). Of these, 64 women in the AFT group and 68 women in the IBR group completed the 12-months postoperative BREAST-Q. Main BREAST-Q scores were higher in the AFT group in three of five domains; satisfaction with breasts, physical well-being and satisfaction with outcome. Linear mixed-effects regression analysis showed QoL change over time was dependent on treatment group, in favor of AFT. Average volume achieved was 300.3ml in the AFT group vs. 384.1ml in the IBR group. No differences in oncologic events were found (4 AFT, 5 IBR).

Interpretation
These findings corresponded to higher QoL and an increase in QoL scores over time in the AFT group compared to the IBR group. No evidence was found that AFT is unsafe. This is encouraging news since it provides a third reconstruction option for breast cancer patients.