52-year-old female with breast cancer who underwent bilateral total skin sparing mastectomies is shown after breast reconstruction. A right extended periareolar incision was made and her previous lumpectomy incision was used on the left. Immediate first stage reconstruction using tissue expanders and acellular dermal matrix (Alloderm) was performed. 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.