Breast Augmentation in Body Contouring Using Autologous Stem Cell-Enriched Fat Grafting: Fifteen-Year Clinical Experience

<b>Background</b>: Variability and low volume yield in breast aesthetic outcomes utilizing fat grafting promoted a search for surgical technique improvement. <b>Aim</b>: Using evidence-based information to optimize a surgical technique for aesthetic breast augmentation using stem cell-enriched fat grafting. <b>Methods</b>: Retrospective study of consecutive women (n = 118) from 2008 to 2025 requesting breast fat grafting using centrifugation-filtration fat processing combined with platelet-rich plasma and autologous adipose-derived stem cell-enriched fat. <b>Results</b>: Most surgical indications were for primary breast augmentation (65.8%), followed by fat grafting after implant removal (13.6%), during or after mammoplasty (13.6%), or simultaneously with implant exchange (12.7%). The mean volume per breast of purified, enriched fat grafted was 192 to 206 cc. Each patient had fat grafted into the subcutaneous plane with some patients having additional fat placed submuscularly in those without a dual plane or submuscularly placed implant, or where an implant capsule was absent. Most patients were either very satisfied or satisfied (95.8%), with 4.2% dissatisfied. Those dissatisfied were mainly those with insufficient breast volume and one with a suspected atypical mycobacteria infection. There was a 11.9% complication rate, with seroma formation at the harvested site the most common at 5.1% (n = 6). Palpable fibrotic areas were second in frequency at 3.4% (n = 4), but with no instances of breast oil cyst formation. The average number of fat grafting sessions per indication was only one, with 6.8% requesting a second staged fat grafting procedure. The revision procedures were only in patients with a sole augmentation indication, except for one mastopexy patient with severe breast size asymmetry. An estimated 75-85% grafted volume take was confirmed by a previous diagnostic ultrasound measurement study. <b>Conclusions</b>: Breast fat grafting incorporating learned knowledge of optimal harvesting, processing, storing, enrichment, and administration techniques yielded superior consistent breast enhancement aesthetic outcomes with a high patient and surgeon satisfaction rate through increased adipocyte survival, while minimizing complications including a low incidence of fibrotic areas and no oil cyst formation.