For a number of years patients would have difficulty with contour abnormalities of the chest wall, breast reconstruction asymmetry, implant rippling in the lower poles and the most visualized medial area.  It was difficult to inform breast cancer patients about using fat grafting because of the inability to reliably tell the patient how it would work in the short and long term.  Now enough work has been done that fat grafting has firmly taken hold in the practice of plastic surgery for a number of problems.  Just as I suggested in the title of this blog, fat grafting is a major player in breast cancer reconstruction.  Even though a have performed numerous DIEP flaps and I am one of the few Plastic Surgeons who will perform two flaps on one side to provide the most volume at one time.  There are instance particularly on the later aspect of the breast where the addition of fat can be extremely helpful in reconstruction the anterior axillary fold.  I also feel that an poorly treated area by plastic surgeons is what refer to as the patient's view.  When a women looks done if there is not adequate breast volume after all of the effort to get reconstruction it is extremely frustrating.  I start the cases by harvesting the fat and then after it has been separated appropriately I begin to inject the fat.  I start with the patient supine and begin to reconstruct the lateral and inferior portions of the breast reconstruction.  Always adding volume and then comparing side-to-side.I gradually have the anesthesiologist raise the patient up  on the operating table to mimic gravity.  I will walk around and look from above to ensure that I am seeing what the patient will ultimately see.  These are just some of the ways I try to give reproducible results when I use fat graft.