The authors present results of a survey of the use of fat grafting by American plastic surgeons in order to benchmark current practices in both aesthetic and reconstructive procedures to the breast. A survey was sent electronically to 2584 members of the American Society of Plastic Surgeons with an 18% response rate. Eighty percent of respondents stated they were using the technique for non-breast related applications and most preferred to use fat grafting to the breast for reconstructive rather than for aesthetic procedures (62% vs. 28%). This was mainly as an adjunct to implants or tissue flaps for reconstruction and as an adjunct to augmentation in aesthetic surgery. The majority used hand-held suction in order to harvest fat (55%) and employed decanting as a processing technique (45%) more so than centrifugation (34%) or filtering (34%). A small number of surgeons (5%) incorporated various additives into the lipoaspirate before reinjection, and very few (8%) used the Brava device for external expansion pre, post or both pre and postoperatively. Most respondents perceived the impact on breast cancer risk and recurrence to be the biggest obstacle to allowing fat grafting to be incorporated into clinical practice despite published studies suggesting this not to be the case. This study shows the increasing utilisation of fat grafting for breast related issues and a recommendation is made to establish a national prospective registry in order to track outcomes after aesthetic and reconstructive applications. One drawback to this publication is the lack of details about the time when the questionnaire was conducted as the results represent only a snapshot in time. Another drawback is the low response rate. It should also be noted that survey data, although representative of practice patterns, should not be construed as evidence supporting these practices.