ObjectiveTo review the diagnosis and management of fat necrosis after autologous fat transplantation of breast.MethodsBased on the latest related literature, the pathology, clinical and radiographic examinations, influence factors, as well as the management of fat necrosis after autologous fat transplantation for breast augmentation and reconstruction were summarized.ResultsFat necrosis after breast autologous fat transplantation is histologically manifested as hyaline degeneration, fibrosis, and calcification. The diagnosis of fat necrosis includes clinical examination, imaging examination (ultrasound, mammography, and MRI), and biopsy. The occurrence of fat necrosis is closely related to patient’s own reason and fat transplantation technology. Optimizing the process of fat acquisition, purification, and transplantation can reduce the occurrence of fat necrosis. Intervention or not after fat necrosis depends on the nature of the nodules. According to the nature of the the nodules, various methods such as simple aspiration, vibration amplification of sound energy at resonance liposuction, or direct excision can be selected.ConclusionFat necrosis after autologous fat transplantation of breast are difficult to control. How to process fat to minimize the injury and maximize the activity of grafted fat needs further researches.