Autologous fat grafting: current state of clinical practice in the Australian setting

**Objective**: This study aimed to gather and present systemic data about current fat grafting practice in Australia. We knew prior to the study that data for Australian fat grafting is limited, so we sought information from distinct sources. Part 1 aimed to present fat grafting data available from the Australian Breast Device Registry (ABDR). Part 2 aimed to present the details of current fat grafting practice by Australian plastic and reconstructive surgeons. **Methods**: In part 1, fat grafting data from the ABDR from its inception in 2012 to 2020 was collected and summarised. In part 2, a comprehensive survey about all aspects of fat grafting practice was distributed to surgeon members of the Australian Society of Plastic Surgeons (ASPS). **Results**: Part 1. The ABDR recorded an 8.4 per cent and 6.0 per cent increase in fat grafting at the time of breast device insertion surgery from 2012 to 2020 for reconstructive and aesthetic procedures respectively. Fat grafting with breast device insertion, in previously irradiated breast tissue, increased from 0 per cent to 17.4 per cent in the same period. Part 2. One in five of all surgeons of the Australian Society of Plastic Surgeons completed the survey. Our survey demonstrated that fat grafting is highly heterogeneous with respect to donor site selection, harvest technique, processing technique, number of sessions required and volumetric follow-up. **Conclusion**: Our study is the first attempt to present national data on fat grafting. It demonstrates clearly that uptake of autologous fat grafting for breast reconstruction and aesthetic procedures is rapidly increasing Australia-wide. It demonstrates that procedural variables of fat grafting are not standardised among Australian plastic surgeons. This indicates that further clinical data relating to patient demographics, procedural variables and outcomes are vital to ensure patient safety, health resource management and to inform best practice guidelines.