Patient had a history of genetic breast cancer risk (BRCA+). She chose to undergo a prophylactic breast reconstruction. She complained of breast drooping (ptosis), poor shape, and wanted to be larger overall. To meet all of these goals, she chose to undergo a multi-stage implant based breast reconstruction. This included a peri-areolar lift to shape the breast and correct the nipple position and placement of round cohesive silicone gel implants (Allergan SCF 650 cc) with fat grafting for contour.