This is a 58-year-old woman who presented with a history of right breast invasive ductal carcinoma. She’d had a right breast mastectomy and implant reconstruction 35 years prior and three implant exchanges in the intervening years. She was experiencing asymmetry due to deflation and contracture of her implant and chose to convert to a right breast stacked DIEP flap reconstruction with removal of her implant and a left breast mastopexy (lift) for symmetry. She underwent one revision surgery with fat grafting. She completed her reconstruction with a 3D right nipple-areolar tattoo done in the office.