Unilateral muscle sparing free TRAM flap / contralateral breast vertical lift / creation of nipple / tattooing of neo nipple and areolar complex. 52 yo 5′ 6″ with previous left mastectomy underwent muscle sparing free TRAM flap left breast reconstruction. Stage two – creation of the neo nipple at the reconstructed breast and a symmetrizing vertical incision only contralateral (right) breast lift followed by tattooing of the reconstructed nipple and areolar complex. Abdomen repaired with an in lay and an on lay mesh – patient continues to do yoga as prior to her reconstructive surgery.