58-year-old woman who developed right breast cancer underwent right total skin sparing mastectomy. Immediate reconstruction using a tissue expander and acellular dermal matrix (Alloderm) was performed. A permanent silicone implant was placed at a second stage. Breast augmentation with a periareolar mastopexy was performed at the same time to improve symmetry. Right nipple reconstruction with subsequent tattooing was performed at a third stage. This patient is shown 4 months after final reconstruction.