This 50 year old mother of two adult children had had multiple previous breast biopsies for suspicious nodules and was most recently diagnosed with extensive DCIS of the right breast. She elected to undergo bilateral mastectomies with immediate reconstruction with tissue expanders and Acellular Dermal Matrix. She had her expanders removed and replaced with smooth round ultra high profile silicone gel implants two months later. She is seen one year following her second stage surgery. She was not concerned about her nipple asymmetry, which was also present pre-operatively and discussed with the patient.