Background:
Autologous fat transfer (AFT) has gained increasing attention as a method for total breast reconstruction after mastectomy, offering natural aesthetics without the use of permanent implants. This study reports our institutional experience using AFT following internal tissue expansion, focusing on clinical outcomes, cosmetic results, and patient-reported satisfaction.

Methods:
A retrospective study was conducted on patients who underwent total breast reconstruction with AFT following mastectomy. After tissue expander was inserted as internal expansion, patients underwent serial autologous fat graft injection with a mean injected fat volume of 150–200 mL per procedure and an interval of approximately 3 months between sessions. The tissue expander was removed in the final session of fat transfer. Clinical outcomes, complications, and cosmetic satisfaction were evaluated at ≥6 months post-reconstruction.

Results:
In this study, a total of 12 patients were enrolled. All patients successfully completed breast reconstruction without major complications. One patient (8.3%) developed postoperative infection, which resolved with conservative treatment. Minor oil cysts were observed in several cases but required no intervention. No local recurrence or fat necrosis was identified during follow-up. At the 6-month evaluation, 10 of 12 patients (83.3%) reported being satisfied with breast contour, softness, and overall appearance by BREAST-Q questionnaire.

Conclusions:
Total breast reconstruction using autologous fat grafting after internal expansion is a safe, reliable, and aesthetically favorable approach for selected patients. It achieves natural results with minimal donor- and recipient-site morbidity. Further prospective studies are warranted to validate these findings.