The demand for Autologous Fat Grafting (AFG) in breast augmentation is increasing. There have been relatively few practical cases in our country compared to other countries; thus, various aspects, such as effective application techniques and post-operative complications, remain to be elucidated. Recently, there has been an increase in the number of high-quality randomized comparative trials, systematic reviews, and domestic original research papers examining the effectiveness and safety of AFG in breast reconstruction and augmentation. It is expected that fat grafting procedures will become standardized as a viable surgical option for breast reconstruction in our country as well. However, achieving this requires a comprehensive reassessment and understanding of the safety and effectiveness of AFG, which considers Japan's unique medical landscape and is based on accumulated evidence. The present study aims to provide a logical explanation based on scientific evidence from both domestic and international sources, while also reflecting on the historical background of AFG, to offer insights into the evidence and prospects of AFG in breast augmentation.

Silicone breast implant (SBI) rupture is a common complication following breast reconstruction surgery. Replacement of the SBI is recommended in cases of evident rupture, and an accurate diagnosis is clinically important. In this study, we compared CT-calculated volumes of SBIs with catalog volumes in 21 cases. Our findings indicate that when the SBI volume is less than 1.08 times the catalog volume plus 8.7 cc, there is a high likelihood of SBI rupture. CT-based volume measurement is useful for detecting SBI rupture after breast reconstruction surgery.

Autologous Fat Grafting (AFG) , which began towards the end of the 19th century, has experienced a complex historical development before achieving the relatively stable outcomes seen today. Throughout this period, the principles of graft survival were elucidated by numerous researchers, advancements in medical technology were made, and medical devices evolved, leading to improved treatment results. Furthermore, the clear effectiveness that outweighs the burden and risks to patients has gradually been recognized in the breast region as well, suggesting that we have now entered the era of practical application of AFG.

This article summarizes basic knowledge regarding fat grafts : anatomy, mechanism of engraftment, and stem cells. Blood vessels are abundant in adipose tissue, and adipose-derived stem cells (CD31- / CD34 +) are present around the vessels. Some cells in adipose tissue die during harvest, and the center of grafted tissue undergoes further necrosis after injection. To increase the retention rate of fat graft, cell death before injection should be minimized, and the harvested tissue should be injected in the form of small particles (as much as possible) into multiple layers. Adipose-derived stem cells secrete various cytokines such as hepatocyte growth factor, vascular endothelial growth factor, and interleukins. In fat graft, therefore, not only morphological improvement but also functional improvement is expected.