Background <p>Autologous fat transplantation to the breast, a minimal invasive technique, has significantly expanded in aesthetic and reconstructive surgery over the past two decades. Initially used for lumpectomy defects or correcting contour deformities post-breast reconstruction, it is now also performed as a stand-alone technique for primary breast augmentation or as a complementary method to implant-based augmentation. However, this surgical technique is associated with a high absorption rate. The use of fat grafts for breast augmentation remains controversial due to concerns about its safety, efficacy, and impact on breast cancer.</p> Methods <p>This review examines the literature on cell-assisted lipotransfer (CAL) and PRP-assisted lipotransfer, comparing fat graft survival, complication rates, and oncological safety with conventional autologous lipotransfer.</p> Results <p>CAL and PRP-assisted lipotransfer techniques demonstrate improved fat graft retention and reduced complications compared to conventional methods. Several studies report a potential reduction in the absorption rate of fat grafts with improvements in aesthetic outcomes.</p> Conclusions <p>While CAL and PRP-assisted lipotransfer have shown promising results in enhancing fat graft survival and reducing complications, there are still concerns about their oncological safety.</p> No Level Assigned <p>This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>