Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast

This policy addresses the use of adipose‑derived stem cells (ADSCs) in autologous fat grafting to the breast—including cell‑assisted lipotransfer, stromal vascular fraction or purified lipoaspirate enrichment—for indications such as breast contouring/volume restoration, reconstruction after mastectomy or lumpectomy, treatment of radiation‑induced soft tissue injury (LENT‑SOMA grade 3–4), post‑mastectomy neuropathic pain, and correction of volume deficits after reconstruction. However, ADSC‑enhanced fat grafting is considered experimental, investigational and not covered under this policy; coverage depends on the member’s specific benefit plan and applicable state law, and available evidence is limited to small nonrandomized studies with uncertain long‑term safety and oncologic implications.

"Autologous fat grafting for contouring purposes to improve breast shape and volume."