This 39 year old mother of two presented with a left breast carcinoma. She underwent left therapeutic and right prophylactic mastectomy and placement of bilateral tissue expanders with insertion of Alloderm (R) acellular dermal matrix, followed by radiation therapy for her left breast, chemotherapy, and second stage removal of her expanders and replacement with permanent silicone gel filled prostheses. Her nipple areola reconstructions were accomplished with tattoo only.