The patient presented had mastectomy and radiation therapy on the left for breast cancer. She elected to have a right prophylactic mastectomy. A latissimus flap was indicated on the left to minimize problems related to the radiation. The patient, however, had enough relatively thick preserved skin after her right to make a lattisimus flap on that side unnecessary. In this setting, additional tissue would have made the right droop more than the left and actually contribute to asymmetry. In some instances where the non radiated side has little extra tissue or if the patient desires thicker coverage or larger implants, bilateral latissimus flaps may be indicated. Sometimes, however, the right decision is not completely evident and alterations at the time of implant exchange may be needed.