An application of the LeJour vertical mammaplasty skin pattern for skin-sparing mastectomy is presented. The approach provides adequate access for the mastectomy, axillary dissection, and immediate breast reconstruction. The technique is ideal for patients with large or ptotic breasts undergoing a simultaneous contralateral breast reduction or mastopexy. It is particularly suitable for autogenous tissue reconstruction. Its use in mastectomies for cancer and prophylactic subcutaneous mastectomies is described.