50-year-old woman with previous right breast cancer treated with lumpectomy and radiation therapy who was diagnosed with a new right breast cancer. She was treated with bilateral mastectomies via a vertical approach. She had immediate reconstruction of the right side with a latissimus flap and expander utilized because of previous radiation therapy and the left side with an expander with Alloderm(lower pole sling). The second stage reconstruction exchanged tissue expanders for silicone gel implants. She will require bilateral nipple reconstruction with areolar complex tattooing.