This is a 56-year-old woman who presented with a history of right breast invasive ductal carcinoma. She’d had a bilateral mastectomy and silicone implant reconstruction four years prior, and was experiencing asymmetry and pain in her breasts due to capsular contracture of her implants. She chose to convert to a bilateral DIEP flap reconstruction with removal of her implants. She underwent one revision surgery that included fat grafting and nipple reconstruction. She completed her reconstruction with nipple-areolar tattooing done in the office.