Abstract
BACKGROUND: Autologous fat grafting (AFG) has become increasingly used in reconstructive surgery due to its accessibility, safety, and regenerative potential. In head and neck cancer (HNC) patients, however, concerns remain regarding its oncologic safety, particularly due to the presence of adipose-derived stem cells (ASCs), which may theoretically influence tumor recurrence. This scoping review aims to synthesize current evidence regarding the safety of AFG in this unique patient population. MATERIAL AND METHODS: The review was conducted following the PRISMA-ScR guidelines. PubMed and Scopus databases were searched up to December 2024 using the terms "autologous fat grafting," "lipofilling," "head and neck cancer," and "oncologic safety." Eligible studies included clinical or experimental works reporting on AFG in HNC patients with oncologic outcome assessment. Exclusion criteria included purely aesthetic procedures and studies without relevance to oncologic safety. Data were extracted on study design, patient population, fat grafting technique, follow-up, and reported oncologic outcomes. RESULTS: Five key studies fulfilled the inclusion criteria: A multinational survey of surgeons (Fiedler et al., 2021), a retrospective cohort study of parotidectomy patients (Boschetti et al., 2023), a narrative review on craniofacial oncologic patients (Drochioi et al., 2019), a retrospective series of 116 patients (190 procedures) (Kamali et al., 2018) and a retrospective cohort with radiation-induced fibrosis (Griffin et al., 2019). Across these works, no evidence of increased recurrence or metastasis following AFG was reported. Favorable functional and aesthetic outcomes were consistently observed, although methodological variability and short follow-up durations limited the robustness of conclusions. CONCLUSIONS: Current evidence suggests that AFG is oncologically safe and beneficial for reconstructive purposes in head and neck cancer patients, improving contour and tissue quality. Nevertheless, the lack of large, prospective, and long-term studies precludes definitive recommendations. Standardized protocols and extended oncologic follow-up are essential to confirm safety and guide future clinical practice.