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This 44-year-old female had a multiple staged breast reconstruction plan. The plan began with a double mastectomy and placement of her tissue expanders. Following tissue expansion, she underwent a secondary procedure of placing her permanent implants. After the implant surgery, she wanted to tweak a few things and so, together we decided to perform fat grafting for added cleavage and replacing her implants with Allergan 800cc cohesive silicone gel. The final step in her plan was tattooing her nipples.