49-year-old female with breast cancer who underwent bilateral total skin sparing mastectomies is shown after breast reconstruction. A single periareolar incision 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. This woman is shown 4 months after second stage reconstruction and is pleased with her results.