The patient is a young woman who had breast cancer on the left requiring mastectomy, but not radiation therapy. Expander and implant reconstruction only would have left her with superior fullness on the left and significantly asymmetric versus the right. The addition of an implant on the right for a superiorly round shape would have made the right too large for the left’s maximum potential volume. The solution was to add a latissimus flap on the left. This would allow enough expanded tissue to accommodate a larger implant to match the appropriately sized implant used the right. The trade off for optimal shape and size in a unilateral mastectomy defect in this case was undergoing a latissimus flap. The patient tolerated the process well. Studies show at one year that patients usually have minimal residual pain and have near baseline function secondary to recruitment of synergistic muscles.