There are many patients who choose to undergo bilateral mastectomy for breast cancer or prophylactically to prevent cancer when patients have a genetic predisposition. In patients who are not going to receive radiation the breast is amenable to reconstruction with tissue expanders and implants. The tissue expander is placed at the time of the mastectomy and only a small amount of volume is placed in the expander at the time of the mastectomy. This small volume allows the skin and nipple areola complex to heal without any additional stress on the skin. Once the skin and nipple areola complex have healed, volume is added to the expander at around two weeks post-operatively, provided the patient is healing well. Typically, patients return to the office once a week for several weeks until the desired volume is achieved. Once the desired volume is achieved, the tissues are allowed to relax for several months and then the expanders are removed and replaced with silicone gel mammary prosthesis. The superior peri-areolar incision with lateral extension allows for excellent healing of the nipple areola complex and inferior pole skin.