The use of fat grafting in breast surgery has become a well-established method with several indications. Although the roots of autologous fat grafting have hypoplasia indications, there are new, aesthetic, and revisional indications emerging that include conversions (e.g., breast implant replacement with fat) and hybrid/composite augmentation (e.g., implant enhancement to modify volume and/or shape). These options have indications for both simultaneous and delayed approaches. This evolution in indications is particularly important given the advent of troubling conditions such as breast implant-associated anaplastic large-cell lymphoma, breast implant illness, and capsular contracture. But changing times and tastes, including patient’s desires to remove implants altogether, call for surgeons to also include these procedures as part of their armamentarium. We will describe the new indications, types, and timing of augmentation together with the recommended technique in these different indications, specifically fat processing via the vibration technique using MicroAire technology and decanting.