Mastectomy reconstruction with implants is a viable option in the non-radiated patient. The outcomes are variable and often depend on implant selection, implant size, and quality of the skin post mastectomy. We are seeing an increase in the number of patients who wish to remain the same size following their mastectomy or to go slightly smaller. I learn from my patients on a daily basis. Paying attention and trying to hear what the patient desires in terms of size and shape is challenging for the aesthetic and reconstructive surgeon. In some patients post-mastectomy, the nipple areola complex can be placed into a new position. This depends on the degree the nipple areola complex is to be elevated or moved and the quality of the skin post mastectomy. The patient in the photograph is post bilateral mastecotmy and implant reconstruction with mastopexy.