This is a 23-year-old female who was found to have right breast invasive ductal carcinoma. She underwent a bilateral mastectomy with immediate DIEP flap reconstruction. After completing chemotherapy, she had several short visits to operating room to restore breast volume with fat grafting (fat harvested from her thighs) and she had nipple reconstruction. She underwent nipple-areolar tattoos in the office. On long-term follow up, she gained weight.