Bilateral muscle sparing free TRAM flaps. 37 yo 5′ 9″ with right breast cancer elected to undergo bilateral mastectomy and same time breast reconstruction. Patient underwent bilateral skin sparing mastectomy and bilateral muscle sparing free TRAM flap reconstruction. Patient was “D” cup pre op and is same post op with a tighter and firmer abdomen post three years without any abdominal deficits. Patient had in lay and on lay mesh repair often abdominal muscle donor sites. Patient has elected not to undergo nipple and areolar reconstruction at this time. The reconstructed breasts remain soft, natural to touch complemented by her shapely midsection.