Breast Reconstruction - Direct-to-Implant: Case 2 - Bilateral Nipple Sparing Mastectomies This is a 50-year-old woman who had the BRCA-2 genetic mutation. Because of her high risk of developing breast cancer, she decided to proceed with bilateral prophylactic nipple sparing mastectomies. Breast reconstruction was planned with a direct-to-implant, "one-step" approach using gel implants and AlloDerm. After bilateral mastectomies with immediate direct-to-implant and AlloDerm breast reconstruction, she has better breast symmetry. She has 400cc textured round moderate profile implants which provide a natural appearance to her breast reconstruction.