Breast Reconstruction - Expander-Implant: Case 1 - Bilateral Nipple Sparing Mastectomies This 47-year-old woman with a strong family history of breast cancer decided to proceed with bilateral prophylactic nipple sparing mastectomies and immediate breast reconstruction. At her initial consultation, she expressed a desire to have a fuller breast volume following implant breast reconstruction. As such, staged surgery was planned with bilateral tissue expanders and AlloDerm reconstruction at the time of her mastectomies followed by exchange for her final breast implants at a later date. The incisions for the mastectomies and reconstruction were made along the upper border of each areola extending laterally on each breast. The temporary expanders were expanded in the office during the healing phase after her first surgery, in preparation for the second stage of reconstruction. The second stage was then performed as a short ambulatory procedure where the expanders were removed, the implant pocket shaped and the final implants were placed, resulting in a more natural appearing breast reconstruction. She opted to then proceed with additional revision surgery with fat grafting to further improve her breast reconstruction.