This woman in her 50's had prior history of lumpectomy and radiation on the left side. She had a recurrence on the left side, leading to the necessity for left total mastectomy. She opted for right-sided prophylactic mastectomy. She underwent bilateral mastectomy, sparing the nipple on the right. She was reconstructed with expander on the right and latissimus flap from the back with expander on the left. She later underwent left nipple reconstruction with tattoo and bilateral silicone implant exchanges for the expanders.