This 65 year old woman had a prior left lumpectomy and radiation for DCIS in he left breast many years ago, when she also underwent a prior breast lift by another surgeon. She presented with a new diagnosis of DCIS in her right breast. She underwent bilateral mastectomies and immediate breast reconstructions with placement of tissue expander on her right side and a Direct to Implant on her left side, but because of poor healing on her previously radiated left side, it became necessary to remove her left breast implant due to poor healing. After several months she underwent a latissimus dorsi flap reconstruction with a tissue expander to offset some of the radiation changes. She is seen before, and three months after completion of her final reconstruction on both sides.