This 52 year-old female presented with failed right breast implant-based reconstruction. She underwent delayed left breast reconstruction with deep inferior epigastric artery perforator (DIEP) flap reconstruction. The patient had ptosis (drooping) of both breasts that was corrected with a mastopexy (breast lift) of the reconstructed right breast and the native (unaffected) left breast. Nipple reconstruction and micropigmentation (3D nipple and areola tattooing) was performed on the right breast. As evident in the postoperative photographs, a larger degree of skin is required in delayed reconstructions (those not performed at the same time as mastectomy). This can be seen as a larger circle of skin at the right breast that comes from the abdominal donor site and doesn’t match the surrounding breast skin tone and color.