This 35 year old mother of 2 was BRCA2 positive and had lost her mother and sister to breast cancer. She elected to proceed with bilateral nipple sparing prophylactic mastectomies and immediate “Direct to Implant” reconstruction using acellular dermal matrix. She also underwent removal of her ovaries by her gynecologist during the same procedure, at the advice of her oncologist. SHe is seen before, and six months after her surgery.