Patient presented with right breast cancer with plans for nipple-sparing mastectomy. She desired for prophylactic mastectomy and reconstruction on the contralateral side. After careful consideration, patient opted for implant-based breast reconstruction. As such, she underwent staged reconstruction in following stages: 1) bilateral nipple-sparing mastectomy and insertion of tissue expanders and acellular dermal matrix. The expanders were inflated weekly until the desired volume was reached. 2) Removal of tissue expanders and insertion of permanent smooth round silicone implants. Fat grafting was also performed to improve symmetry and upper pole fullness of her breasts.