Optimization of fat grafting to attenuate radiation damage: a narrative review.

Abstract

Background and objective: Radiation-induced fibrosis (RIF) remains a progressive complication of cancer therapy that compromises tissue quality and reconstructive outcomes. Autologous fat grafting (AFG) has emerged as a regenerative strategy to mitigate radiation damage. However, clinical outcomes remain variable, and efforts to enhance outcomes have largely focused on improving graft survival, angiogenesis, and reduction of fibrotic remodeling. This review aims to highlight recent advances in fat grafting to resolve fibrosis and new evidence for closely related adverse conditions.

Methods: In this narrative review, an overview of existing knowledge and recent research in the use of fat grafting to attenuate RIF is presented. The article is based on a literature search in PubMed with the keywords "fat graft" and "adipose" in addition to the senior authors' clinical experience in breast reconstruction.

Key content and findings: Research continues to evaluate specific adipose-derived stem cell (ADSC) populations to improve graft survival with limited progress towards clinical application. In addition, several pharmacological strategies combined with AFG have been evaluated in murine models to mitigate RIF and improve fat graft outcomes. Emerging data on decellularized adipose matrix (DAM) shows promise and may be ideal for patients with insufficient adipose tissue. Given the ADSC population variability between donors, research studies could benefit from analyzing the adipose tissue as this remains poorly characterized. Most strategies involved in AFG enrichment involve procedures that would require Good Manufacturing Practice (GMP) handling or use of medicines outside of their indications, which would be considered burdensome in a clinical setting.

Conclusions: This review examines current cellular therapy, pharmacologic treatments, and prophylactic strategies aimed at enhancing fat graft survival and discusses applications beyond attenuating fibrosis with specific indications focused on resolving secondary lymphedema, neuropathic pain, and wound healing with promising though limited clinical evidence.