This patient underwent bilateral total mastectomy with staged implant and alloderm tissue grafting reconstruction. First stage tissue expander and sequential rapid air expansion allows for improved aesthetic shapes. All air is replaced by saline about 4 weeks after mastectomy. Subsequent second stage surgery to replace expander with implants and shape the space with lift and capsulectomy really refine the outcome. Ultimately the best cosmetic surgery breast outcome but in a mastectomy case is truly remarkable! A beautiful result.