30 year woman with a strong family history of breast cancer underwent prophylactic bilateral total skin and nipple areolar sparing mastectomies. She had pervious cosmetic breast augmentation with saline implants approximately 5 years before mastectomy. She wished to achieve an “augmented” look with her reconstruction. Immediate reconstruction was performed with tissue expanders and aceullar dermal matrix (Alloderm). Second stage reconstruction was performed with placement of permanent silicone implants. She is shown 4 months after final reconstruction.