41 year old female with right breast cancer who underwent bilateral mastectomy. A right skin sparing mastectomy and a left skin and nipple areolar sparing mastectomy was performed. Immediate reconstruction was performed using smooth round moderate plus profile silicone implants. The implants were placed underneath the pectoralis muscle and an aceullar dermal matrix (Alloderm) sling was constructed to provide improved contour and reinforce the lower portion of the breast. The patient is shown 4 month after surgery.