A women with a breast cancer gene (BRCA-1) giving her a life-time risk of developing breast cancer exceeding 70%. She elected to undergo bilateral risk reduction mastectomies with nipple-areolar sparing technique through her breast fold and had immediate reconstruction with expanders and Alloderm. Final reconstruction exchanged the tissue expanders for silicone gel implants with associated microfat grafting to fill in contour defects and soften the appearance of the impants.