Patient presented with left breast cancer with plans for skin-sparing mastectomy. She desired for symmetry but did not want prophylactic mastectomy on the contralateral side. After careful consideration, patient opted for autologous breast reconstruction for the cancer side and mastpexy on the contralateral side for symmetry. As such, she underwent left skin-sparing mastectomy followed by immediate left breast reconstruction with deep inferior epigastric perforator (DEIP) flap (using tummy tissue to make breast mounds). After several months, a revisional surgery was performed to improve on the appearance of the breasts, which included mastopexy on the contralateral side and fat grafting to both breasts improve symmetry and upper pole fullness of her breasts.