Patient is a pleasant 57-year old Caucasian female, initially referred to me by her medical oncologist. I initially saw patient in consultation in 2009 regarding possible breast reconstruction options. She had been recently-diagnosed with diffuse, high-grade DCIS of her left breast. Of note, she had a history of intraductal carcinoma (ER (+)/ PR (+)) of the right breast for which she underwent a mastectomy with axillary lymph node dissection in Anchorage, Alaska in 1987. She had a lengthy breast reconstruction at that time using a right latissimus dorsi myocutaneous flap and small implant. She had some type of operative revision of her breast reconstruction in 1989. She denied receiving any radiation therapy. She then underwent left total mastectomy with axillary lymph node dissection in 2009, and I then performed immediate reconstruction with a submuscular Tissue-expander that was filled with 100 cc sterile saline. She complained that her old right, reconstructed breast was too small and didn’t “look right”. At the same setting, I performed a revision of her right breast reconstruction that had developed severe capsular contracture and deformity, and was also much too small in size in comparison to patient’s left breast. I approached the breast via an inframammary incision, performed Capsulectomy and Capsulotomies, and removed a small, smooth, round 90 cc silicone implant that was intact. I then placed Alloderm and an Allergan Tissue Expander with a total fill-volume of 500 cc into the pocket and filled the expander with 70 cc of sterile saline. She went on to heal well and had tissue expansion performed on an outpatient basis. She then underwent Removal of her Tissue Expanders and Replacements with Allergan (Natrelle) silicone gel, Style 20 (high-profile) implants- 500 cc on the left side and a 550 cc on the right side. She had improved size, shape and symmetry. Finally, she had Bilateral Nipple-Areolar Reconstructions with local flaps and did not desire tatooing. She is now extremely happy with her overall result.