The patient is a 58 year old woman who presented with invasive right breast cancer. She elected for bilateral total mastectomies to address her cancer and to prevent future cancer. She underwent immediate bilateral breast reconstructions with tissue expanders. Approximately four months later, she underwent exchange of her tissue expanders to permanent silicone breast implants. She also underwent autologous fat grafting to provide additional contour improvements around her permanent implants. Four months following her second stage reconstruction, she underwent bilateral nipple reconstructions with additional fat grafting. The abdominal scar is due to gallbladder surgery in the remote past. She is seen here 3 months after the completion of her reconstruction, following bilateral nipple tattooing. She is pleased with her final result and has resumed normal activities.