This 40 year old woman with a strong family history of breast carcinoma sought to have bilateral nipple sparing mastectomies and immediate reconstruction with tissue expander placement and ADM (Acellular Dermal Matrix) followed by second stage insertion of silicone gel filled implants. She requested to be the same size post-operatively as she was pre-operatively. She is seen two months after her surgery with her scars still a bit pink and some creases on her skin from her bra.