Unilateral tissue expander breast reconstruction / contralateral symmetrizing breast reduction / creation of nipple / tattooing. 47 yo 5′ 7″ underwent left mastectomy and same time tissue expander breast reconstruction, full muscle coverage. Second stage – replacement of expander with anatomic shaped 700cc saline textured implant and contralateral (right) breast symmetrizing reduction. Third stage – creation of left breast nipple and fourth stage – tattooing of nipple and areolar complex. Note symmetry in size, shape, contour and overall proportion to body habitus.