Complete breast reconstruction with fat grafting is an appealing technique because it does not add scars or use flaps, is autologous, and has the secondary benefit of liposuction. It is a multiple stage surgery and usually requires balancing of the contralateral breast. After using this technique since 2001, the authors narrowed the indications, the ideal candidate being a patient with small breasts and enough donor sites for up to 4 or 5 lipomodeling sessions. Breast reconstruction with fat grafting alone in total breast reconstruction has very limited indications, because lipomodeling in combination with other autologous reconstruction gives very nice results.