This 49 year young energetic mom of three children had a strong family history of breast cancer. Biopsies demonstrated pre-cancerous changes in the left breast. Based on that information and the fact that her sister developed breast cancer at a very young age it was recommended that she have a bilateral prophylactic mastectomy. She decided to have bilateral nipple-sparing mastectomies with expanders placed at the time of surgery followed with implants 4 months later. Her incisions were all concealed in the breast crease. She is seen 3 years post op elated with her surgical outcome. Since she always desired a larger breast volume she took the opportunity at the time of surgery to increase her overall breast size with use of high profile 650cc silicone gel implants.