BACKGROUND: Over the last 30 years there has been interest in the use of autologous fat transplantation for breast reconstructive and cosmetic purposes. Up until now injection of adipose tissue into the breast has been subject to two limiting factors. First, fat injection into the breast could result in fat necrosis, cyst formation, and indurations that could be mistaken as cancerous calcifications. Second, the degree of reabsorption of the injected adipose tissue is unpredictable. METHODS: Patients included in the study were candidates for either breast reconstruction after tumor resection or breast augmentation and were divided into three groups. Group I included patients with asymmetry after mastectomy and breast reconstruction; Group II consisted of patients with congenital breast asymmetry; and Group III included patients requesting bilateral breast augmentation. All patients signed a consent form acknowledging potential complications of infiltrating fat into the breast. RESULTS: A total of 820 consecutive female patients were operated on between 1983 and 2007. The age distribution of the patients ranged from 19 to 78 years, with a mean of 45.6 years. There were 381 patients in Group I, 54 in Group II, and 385 in Group III. Complications included ecchymosis in 76 patients, striae in 36 patients, 12 hematomas, and 5 infections. Long-term breast asymmetry was observed in 34 cases. Six hundred seventy patients have undergone mammography and ultrasonography 6 months and 1 year after their first intervention under our care. The majority of complications resulting from lipofilling of the breast have been seen in this series during the first 6 months after each session. Breast lesions, including calcifications, cysts, and cancer, that are not apparent in the first year after the final procedure of lipofilling we believe may not be directly associated with the autologous fat grafting to the breast. This has been confirmed by the long-term follow-up of 230 patients (range = 2-25 years, mean = 11.3 years) who have been followed up yearly with mammographic examination. CONCLUSION: In the last 25 years the results of autologous fat transplantation have been predictable and satisfying on the condition that the treatment is performed in stages with small quantities of adipose tissue fat injected in each treatment session. To prevent major complications the final expected result should not be the aim of a single procedure. Mammary lipografting is a procedure that can be offered to patients for breast reconstructive and cosmetic purposes.