This 35 year old woman with a very strong family history of breast cancer in her mother, maternal grandmother, maternal great grandmother, maternal aunt, and maternal great aunt, elected to proceed with prophylactic bilateral nipple sparing mastectomies and immediate reconstruction. She is seen before and 18 months after immediate insertion (Direct to Implant) immediate reconstructions with 700 cc High Profile silicone gel prostheses and use of Alloderm acellular dermal matrix.