Using oncoplastic techniques we are able to place our implants at the time of the initial surgical procedure . Giving the patient a new breast the day of the mastectomy spares her from the trauma of a flat chest and the pain and time investment of the tissue expansion process. The implants are placed on top of the pectoral muscle and secured in place with sheets of acellular dermal matrix ( sheets of collagen made fron animal skin ). By placing the implant over the pectoral muscle a natural looking breast reconstruction is achieved, since the implant is placed in the physiologic location of the breast tissue and not under the chest muscles. If the breast surgeon and plastic surgeon work together as a team immediate implant reconstruction is a very safe reliable procedure allowing patients to achieve a natural looking reconstruction in a single step surgery. We recommend a fine tuning of the initial reconstruction a few months after the first procedure with fat transfer into areas of soft tissue deficiency. We have performed this procedure for over a decade now and have hundreds of happy patients with very low complication rates.