A single case is reported utilizing, recipient site pre-expansion With BRAVA (Brava, Inc, Miami, FL) followed by autologous fat grafting to the breast in a patient with severe breast asymmetry, Recipient site preexpansion, used 2 to 3 weeks before fat grafting and 2 weeks after fat grafting may have both practical and theoretical benefits in optimizing the volume and enhancing the survival of grafted adipocytes, the mechanism of which is discussed. Recipient site pre-expansion and fat grafting may have early clinical adoption in cases of severe asymmetry, tuberous breasts, and other deformities that are difficult to treat with current reconstructive techniques, but studies are needed to clearly delineate its safety and its role.