Sometimes, TRAM flap only is not enough to accomplish symmetric breast reconstruction. Although many secondary procedures have been used to obtain symmetry, only a few studies have been performed to validate the result of fat grafting after TRAM flap breast reconstruction. From January 2004 to July 2008, 96 patients who underwent fat grafting after TRAM breast reconstruction were reviewed. The fat grafting was performed after 6 months following breast reconstruction. Assessments were retrospectively carried out according to the breast reconstruction type, injection volume, injected area, donor site, and complications. Immediate breast reconstruction cases were 92 out of 96 cases, and rest of them was cases of delayed reconstruction. Mean injected volume was 31.7 cc(3-113.5cc). Recipient sites were upper medial and lateral quadrants(85.4%) in 82 cases, upper medial quadrant in 5 cases, all four quadrants in 3 cases and lateral upper quadrant in 2 cases. Any specific complication such as fat embolism, infection, fat necrosis and skin necrosis was not noticed. We obtained a satisfying result in every case without any specific complication. Therefore, fat grafting can be one of the useful options to match the contour of reconstructed breast after TRAM flap reconstruction.