This 51 year-old woman developed an aggressive right sided breast cancer which extended to the skin surface above the right nipple. In addition, she had underlying breast asymmetry with her left breast being smaller than right since a young age. Bilateral mastectomies were performed. She required a large resection of skin above the right nipple to remove the tumor which resulted in a vertical scar above the right nipple. An immediate breast reconstruction was performed with bilateral Latissimus muscle flaps and tissue expanders. Several months later, the expanders were replaced with slightly different size moderate-profile silicone gel breast implants (i.e. larger implant on the left to account for underlying asymmetry). In addition, a nipple reconstruction was performed with local skin flaps and skin grafts from the lower abdomen. Postoperative result at 2 years shows excellent symmetry and a natural breast contour.