This 44-year-old BRCA1+ woman is 9 months after nipple sparing double mastectomy and immediate reconstruction with DIEP flaps and breast implants. Her protuberant abdomen was due to a very wide rectus diastasis (weakening and separating of her midline abdominal muscles) and less so from excess tummy skin. Her tummy tuck skin and fat was used as DIEP flaps for breast reconstruction; because she deisred more breast volume than her tummy tuck skin could give, breast implants (250 and 300cc smooth silicone implants) complemented her reconstruction. The incision for her mastectomy was designed as a vertical incision, keeping in mind that she may desire a breast lift after all this was done. Three months after her initial reconstruction and mastectomy, a planned breast skin lift using the same incisions as well as fat grafting was done to further enhance her results.