Patient presented with newly diagnosed right breast cancer in setting of previous left breast cancer. For the left breast, she underwent lumpectomy followed by radiation but was left with significant breast deformity. As such, she desired correction of the left breast as well as options for the right breast with plans for skin-sparing mastectomy. She did not want autologous reconstruction. After careful consideration, patient opted for implant-based breast reconstruction on the right breast and serial fat grafting on the left breast and pocket revision to improve the appearance of this breast. As such, she underwent staged reconstruction in following stages: 1) right skin-sparing mastectomy followed by immediate reconstruction with insertion of tissue expander and acellular dermal matrix. She also underwent subcision and revision of left breast with fat grafting at the same time. The expander was inflated weekly until the desired volume was reached. 2) removal of tissue expander and insertion of permanent smooth round silicone implant, and another round of fat grafting, this time to bilateral breasts to improve symmetry and upper pole fullness of her breasts.