This 47 year-old female developed right sided breast cancer and was recommended by her oncologist to undergo a right sided mastectomy. A right sided areolar-sparing mastectomy (which removes the breast and nipple but leaves behind the natural transition of the pigmented areolar skin) was performed by her breast surgeon. At the same time, an immediate breast and nipple reconstruction with a latissimus muscle flap (from the upper back) and a tissue expander was performed. The skin on the latissimus muscle was repositioned to create a new nipple. Several months following expansion, the right-sided expander was removed and changed to a high-profile silicone gel implant. In the left breast, a lower profile silicone implant was placed for symmetry. Postoperative result shows a natural-appearing and symmetric right breast reconstruction at 1 year.