This 57 year old woman had undergone a previous right mastectomy without reconstruction, followed by radiation therapy and chemotherapy. She underwent a first stage right breast reconstruction with a latissimus dorsi musculocutaneous (“LD”) flap and placement of tissue expander. Once she was fully expanded to her desired final breast size, she underwent a removal of her expander with replacement a silicone gel implant. At the same time she underwent a prophylactic left mastectomy and immediate Direct to Implant (DTI) reconstruction with acellular dermal matrix (“ADM”) and her final silicone gel implant. She is seen before, and one year after her second of two operations, prior to nipple reconstruction.