Reconstructive and aesthetic fat grafting has been introduced to the breast level over the last years. The safety of such procedures has so far not been completely clarified. The concept has now been refined to stem cell enhanced fat grafting. However beside the promise of using adult stem cells in terms of tissue rejuvenation and augmentation, scar treatment and reconstruction, the variance of adipose stem cell function--including angiogenetic, antiapoptotic, immunomodulatory, chemotactic and anti-scarring potential--raises new scepsis about oncological safety. Herein we reviewed experimental and clinical data on fat grafting and stem cell enhanced fat grafting addressing surgical promise and oncological concerns. Based on these data we suggest clinical criteria for patient selection undergoing fat grafting for aesthetic or reconstructive reasons based on their individual breast cancer risk.