39 year who under bilateral total mastectomy with immediate tissue expander reconstruction elsewhere. She presented for revision of her breasts and completion of her reconstruction. Her tissue expanders were exchange for cohesive silicone gel permanent breast implants. Extensive pocket work was performed to reshape the breasts to a more “teardrop” natural shape. Autologous tissue fat transfer (fat grafting) was performed to improve upper pole breast contour and to thicken the overlying soft tissue covering the implant. She is shown 4 months after her previous surgery.