She is a 66-year-old female who underwent a bilateral mastectomy for breast cancer followed by tissue expander placement. Prior to proceeding with surgery she had an extensive discussion with Dr. Neaman about all the potential options for breast reconstruction. She elected to proceed with a tissue expander based approach. After serial expansions in the office she under her exchange for permanent implants with fat grating to the upper pole of each breast. She eventually underwent complex and underwent nipple areolar tattooing by a local tattoo artist.