Survival Mechanisms and Retention Strategies in Large-Volume Fat Grafting: A Comprehensive Review and Future Perspectives.

introductionLarge-volume fat grafting is emerging as a promising technique in plastic and reconstructive surgery. However, the unpredictable graft volume retention rate remains a critical challenge. To address this issue, we need a profound understanding of the survival mechanisms following large-volume fat transplantation. This review summarizes known survival mechanisms and strategies to enhance graft retention.

methodsThis review comprehensively examines the current literature on the survival mechanisms and retention strategies in large-volume fat grafting. A thorough literature search was conducted using PubMed, Medline and Google Scholar databases, focusing on studies published from 2009 to 2023.

conclusionIn the current research on fat survival mechanisms, few have focused on large-volume fat grafting. This review provides an overview of the survival mechanisms specific to large-volume fat grafting and identifies a survival pattern distinct from that of small-volume fat grafting. Additionally, we have summarized existing strategies to improve graft retention across five stages (harvesting, processing, enrichment, grafting and post-graft care), analyzed their advantages and disadvantages and identified some of the most promising strategies. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266.