Patient presented with left breast cancer with plans for skin-sparing mastectomy. She desired for symmetry but did not want to undergo mastectomy on the contralateral side. In addition, she was not a candidate for autologous breast reconstruction. After careful consideration, patient opted for implant-based breast reconstruction on the cancer side and symmetry procedure on the contralateral side. As such, she underwent staged reconstruction in following stages: 1) left skin-sparing mastectomy and insertion of tissue expanders and acellular dermal matrix along with mastopexy on the contralateral side. The expander was inflated weekly until the desired volume was reached. 2) Removal of tissue expander and insertion of permanent smooth round silicone implants as well as revision of the skin envelop and fat grafting on both sides to improve symmetry and upper pole fullness of her breasts.