This 48 year old woman presented with extensive DCIS in her left breast. After extensive discussions with her breast surgeon and oncologist she elected to proceed wit therapeutic left mastectomy and prophylactic right mastectomy, with immediate Direct to Implant (“DTI”) breast reconstructions using acellular dermal matrix (“ADM”). She is seen before, and six months after surgery. Her scars are still pink and not completely mature. Her nipple areola reconstruction is tattoo only.