Breast Reconstruction - Direct-to-Implant: Case 1 - Bilateral Nipple Sparing Mastectomies This is a 46-year-old woman with right breast cancer who underwent bilateral nipple areola sparing mastectomies with immediate direct-to-implant and AlloDerm breast reconstruction. The location of the incisions made a breast lift possible at the time of reconstruction, correcting her pre-operative breast asymmetry. At the time of her initial mastectomies and direct-to-implant breast reconstruction, high profile 325cc silicone-filled smooth round implants were placed bilaterally. Several months after healing from this surgery, she underwent a secondary procedure with fat grafting to the upper part of each reconstructed breast. The additional fat grafting procedure contributed to the natural appearance of her final outcome. Also, the location of the incisions allowed the healed scars to be barely perceptible.