This patient had bilateral mastectomy for breast cancer. Due to her breast cancer, the mastectomy surgeons could not save her nipples. Both her nipples were removed and a scar on the breast was unavoidable. We reconstructed both of her breasts with two stage tissue expander and silicone implants. By focusing on expanding the tissue above her scar, we were able to keep the mastectomy scar as low as possible. Fat was transfer from her legs to soften the look of the implants and her nipples were reconstructed with a tattoo only.