This 58-year old female underwent right mastectomy for breast cancer and failed immediate reconstruction elsewhere.  She underwent delayed reconstruction as a multi-stage procedure. First she had a right breast tissue expander and ADM placed, followed by replacement of the expander with permanent silicone implant. For symmetry she then underwent a right breast capsulorraphy, left mastopexy and silicone implant.   She finished her reconstruction with right nipple reconstruction, tattoo and structural fat grafting of the upper pole of the right breast.