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BACKGROUND: Autologous fat grafting is gaining more widespread acceptance for the management of soft tissue deformities of the reconstructed breast. Traditional techniques use low volume fat grafting and longer processing times requiring multiple stages for injection. Recent advances in the harvesting, transfer and injection of fat have allowed plastic surgeons to become more adept and efficient. We present a single surgeon's experience with higher volume, low G fat grafting in the correction of acquired contour deformities in breast reconstruction. Volume injected, number of procedures, complications, patient and surgeon satisfaction were assessed with at least six months follow-up. METHODS: The charts of 100 female patients who underwent autologous fat transfer procedures for correction of contour deformities over a three year period were retrospectively reviewed. 64% of patients had a history of prior radiation. All patients were grafted through the modified technique as described by Del Vecchio. Clinical and aesthetic results were assessed for patient satisfaction through a validated questionnaire as was surgeon satisfaction including number of procedures required. RESULTS: On average, 158 cc of fat was injected into each breast per procedure. There were 160 fat injection performed as more than one injection was required in 29% of cases. Complications occurred in 4% of procedures. Four patients had cellulitic bouts of the injected breast treated conservatively with oral antibiotics. Aesthetic outcome was improved across all measurements including volume, contour, placement, and superomedial fullness. CONCLUSIONS: Fat injection continues to be a safe adjunct to breast reconstruction and significantly improves the aesthetic results in patients with contour deformities of the reconstructed breast. The use of a modified technique for the harvesting and processing of fat allows the injection of higher volumes in less time, theoretically increasing the viability of the fat cells and thereby decreasing the number of secondary corrections. With a low complication rate, ease of use and improvement in contour, we believe that the transition to higher volume fat grafting is warranted in patients where such volumes are required.