51 year old with breast cancer. She received chemotherapy before bilateral total skin and nipple sparing mastectomies. Immediate single stage direct to implant reconstruction was performed with cohesive gel silicone implants and aceullar dermal matrix. An extended periareolar incision was used for her both mastectomy and reconstruction. She has slightly increased volume and a natural breast contour comparable to her natural breasts. She is shown 4 months after her surgery and is considering fat transfer at this time.