Bilateral mastectomy is often reconstructed with tissue expanders and breast implants. The tissue expander is inserted at the time of the mastectomy and the skin is allowed to heal and more oncologic information is gathered. Once the mastectomy skin has healed, saline is placed in the tissue expander to gradually expand the skin. The expanded skin is allowed to settle for several months and then the expanders are removed and replaced with implants. The most commonly used implant is a silicone gel implant in a smooth round shell. Patient satisfaction with bilateral implant reconstruction is high.