She is a 52-year-old female who underwent a breast reconstruction procedure for breast cancer followed by tissue expander placement. Prior to surgery, she had an extensive discussion with Dr. Keith 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 had her tissue expanders exchanged for permanent implants with fat grafting to the upper pole of each breast as an outpatient procedure. She will likely undergoing 3-dimensional nipple areolar tattooing in the future.