The patient is a young woman who had history of bilateral breast augmentation, but now had indications for mastectomies. (It should be noted that breast augmentation does not put a woman at higher risk for breast cancer.) Because she had already, in effect, been pre-expanded by her breast implants and because she had a relatively small breast with no ptosis, she was a good candidate for immediate nipple sparing mastectomy with immediate tissue expander placement. In the early post op photo (the cord under the skin on the left breast is a drain tube), breast looks deflated and traumatized. Ultimately, after expansion, she progresses to a very nice post op result. Compare the upper part of the breast with the expanders in place – there is more of an evident border and the saline filled device ripples under thin coverage. Now consider the final result with a form stable silicone implant with the smoother upper pole and no rippling seen.