This 40 year-old female developed left sided breast cancer. Because of an extensive family history of breast cancer, she opted for bilateral mastectomies. Bilateral areolar-sparing mastectomies (which removes the breast and nipple but leaves behind the natural transition of the areola) were performed by her breast surgeon. At the same time, bilateral immediate breast and nipple reconstructions with a latissimus muscle flap (from the upper back) and a tissue expanders were performed. The skin on the latissimus muscle was repositioned to create a new nipple. Several months following expansion, the expanders were removed and changed to a moderate-profile silicone gel implants. Postoperative result at 1 year shows natural-appearing, symmetric breasts with excellent projection.