SVF-Enriched Versus Standard Fat Grafting for Breast Reconstruction and Augmentation: A Prospective Multicenter Comparative Randomized Study.

BACKGROUND: Autologous fat grafting (AFG) has become a technique in aesthetic and reconstructive breast surgery. However, graft retention remains variable and requires repeated procedures. Stromal vascular fraction (SVF) enrichment has been proposed to improve graft survival through angiogenesis and tissue integration, although comparative evidence remains limited. OBJECTIVES: The endpoint was MRI-based graft retention at 12 months. Secondary outcomes included 24-month retention, complications, BREAST-Q outcomes, radiologic findings, and revision procedures. MRI volumetric assessment was performed using 3-dimensional segmentation protocols and analyzed by breast radiologists. METHODS: A multicenter, randomized controlled study was conducted across six centers between January 2021 and March 2025. Patients affected by bilateral breast hypoplasia, breast asymmetry associated with unilateral breast hypoplasia, breast ptosis/pseudoptosis, and post-lumpectomy defects were randomized to standard AFG or SVF-enriched AFG. RESULTS: 312 patients were randomized (156 per group). Follow-up was 28.6 ± 6.4 months. At 12 months, MRI graft retention was greater in the SVF-enriched group compared with standard fat grafting (71.8% ± 11.2% versus 56.4% ± 13.7%; p < 0.001). Retention persisted at 24 months (66.2% ± 12.0% versus 49.8% ± 14.1%; p < 0.001). BREAST-Q scores were higher in the SVF group at both follow-up intervals. Fat necrosis and oil cyst formation rates were similar between groups. No suspicious MRI findings attributable to fat grafting were identified during follow-up. CONCLUSIONS: SVF-enriched AFG demonstrated improved volumetric persistence and higher patient-reported satisfaction compared with standard AFG, without increased radiologic or clinical complications. MRI-based evaluation may improve reproducibility in future breast fat grafting studies.