32-year-old female with a strong family history of breast cancer underwent bilateral prophylactic skin and nipple-areola sparing mastectomy with immediate reconstruction. First stage reconstruction was performed with tissue expanders and acellular dermal matrix (Alloderm). A single extended periareolar incision was used. The second stage consisted of placement of a permanent silicone implant with pocket revision for symmetry. She is shown 5 months after second stage reconstruction and is pleased with her results.