Background: Autologous fat transfer (AFT) is a minimally invasive technique that employs a patient's own fat to correct disfiguring sequelae for breast reconstruction in postoperative breast cancer patients. However, the results of studies on this topic were controversial. In order to explore the effect of AFT on breast reconstruction after breast cancer surgery, we included cohort studies and conducted a meta-analysis.Methods: A literature search was conducted using PubMed, Embase, Cochrane Library, and Web of Science databases for relevant studies published up to September 14, 2020. We identified the eligible studies based on the PICOS principles, populations (patients diagnosed with breast cancer), interventions (patients undergoing AFT after breast cancer surgery), controls (patients who did not receive AFT after breast cancer surgery), outcomes [local recurrence (LR) rate, regional recurrence (RRR) rate, locoregional recurrence (LRR) rate, distant metastasis rate, systemic recurrence (SR) rate, and total death rate], study design (cohort studies). The I 2 statistic was conducted to estimate heterogeneity. Relative risks (RRs) with 95% confidence intervals (CIs) were presented to evaluate whether AFT compromises oncological safety in breast reconstruction. Funnel plots and Egger's test were adopted to assess publication bias. Quality assessment for the included studies using the Newcastle-Ottawa Scale (NOS).Results: Twenty-two cohort studies involving 9,971 postoperative patients with breast cancer were identified, with 3,622 receiving AFT being the experimental group, and 6,349 not receiving AFT in the control group. The overall quality of the included studies was rated as high. No significant differences in the