The authors present multiple-stage breast reconstruction after previous skin-sparing mastectomy with single-stage autologous TRAM flap reconstruction and subsequent flap liponecrosis. The patient with left-sided breast cancer underwent treatment including neoadjuvant chemo- and radiotherapy. The last ones are risk factors of flap liponecrosis. Fat necrosis is a common complication after autologous breast reconstruction. This event may be asymptomatic in most cases and also symptomatic with necessary surgical intervention. If fat necrosis leads to flap loss, surgeons still have different options to recreate the breast from lipofilling of small defects to expanders and implants. This case report is important due to no clear guidelines for the management of patients with fat necrosis after autologous breast reconstruction.