43-year-old female with breast cancer who underwent bilateral total skin sparing mastectomies is shown after breast reconstruction. A single inframammary incision hidden within the crease of the breast was used. Immediate reconstruction using tissue expanders, acellular dermal matrix (Alloderm) was performed during the first stage. The second stage consisted of placement of a permanent silicone implant with autologous tissue fat transfer. The patient also underwent simultaneous abdominoplasty to remove excess skin and fatty tissue for the lower abdomen. This woman is shown 4 months after second stage reconstruction and is pleased with her results. She will undergo nipple reconstruction, areolar tattooing, and additional fat transfer in the near future.