* Here is a 51 year old woman who presented with a need for bilateral mastectomies due to breast cancer. She was interested in having immediate breast reconstruction. The first detail that needed to be addressed was the fact that she wanted to have smaller breasts, so a breast reduction pattern was designed into her skin sparing mastectomy plan. The next decisionto be made was how to fill the defect. It was decided to use tissue expanders covered by the deep layer of skin left over from the reduction of her breast envelopes. The first stage was completed as planned. Six months later her expanders were replaced with smooth round gel breast implants. Fat grafting was added to the superior pole of her breasts to soften the contours. Then she made the decision to have nipple and areolas simply tattooed onto her breasts rather than reconstructed and then tattooed. Our cosmetic tattoo artist is just that; an artist. As you can see the tattooed NAC’s give the allusion of depth with the shading that she does. Her result is a very fine breast reconstruction that also gave her a breast reduction with minimal surgery and recovery time.