This patient tested positive for a BRCA gene mutation, putting her at high risk for future breast cancer. She chose to undergo bilateral mastectomy with implant-based reconstruction. Since she had a moderate amount of asymmetry and ptosis (sagging) of the natural breast, we chose to perform a mastopexy (lift) first. This allowed the skin envelope and nipple-areola complex to be lifted. This was followed by nipple sparing mastectomy and implant reconstruction with fat grafting.