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This patient with high risk for breast cancer desired a fuller breast, particularly of the upper pole.  To achieve an increase in volume and projection, she underwent staged reconstruction with nipple sparing mastectomy through an incision along the natural breast fold and immediate pre-pectoral tissue expander placement (on top of the pectoralis muscle).  Once the expanders achieved her desired volume, the expanders were exchanged to a final permanent implant and fat grafting was performed.  Temporary expanders can be helpful to achieve changes in breast volume and shape as for this patient.

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