Background <p>Breast augmentation is the most common cosmetic surgery worldwide. Despite recent approval for aesthetic use, adipose tissue autografting remains underutilized compared to breast implants, the standard for hypoplasia correction.</p> Objectives <p>This study aims to compare patient satisfaction and quality of life following breast augmentation with implants or lipofilling, using the BREAST-Q questionnaire.</p> Methods <p>From July 2017 to 2022, patients from our Plastic, Reconstructive, and Aesthetic Surgery Department who underwent breast augmentation with implants or lipofillin were included. The primary endpoint was patient satisfaction and quality of life, assessed using the BREAST-Q questionnaire at least six months postoperatively.</p> Results <p>Among 119 patients (87 implants, 32 lipofilling), BREAST-Q scores showed no significant difference in breast satisfaction (71/100 vs. 69/100). Psychosocial and sexual well-being scores were similar between groups, while physical well-being was higher in the lipofilling group (96/100 vs. 87/100). Major complications occurred in 3.4% of the implant group, whereas none were observed in the lipofilling group.</p> Conclusion <p>Adipose tissue autografting is an effective technique, providing comparable patient satisfaction to breast implants while offering better physical well-being. It is a viable alternative to implants, particularly for patients seeking moderate breast augmentation or avoiding foreign materials, provided they have sufficient fat reserves.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. 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>