55 yo who had previously lost 80 lbs. from gastric bypass surgery developed right breast cancer treated with lumpectomy. The surgical margins were positive and the patient elected to proceed with a right completion mastectomy and prophylactic left mastectomy. Breast reconstruction was accomplished at the same time with a left DIEP free flap and a right muscle sparing free TRAM flap. Microvascular anastomoses were to the internal mammary vessels. Nipple areolar reconstruction was performed 6 months later. Postoperative photos are taken 1 year following her mastectomies.