Introduction: We present a single center's experience in bilateral breast reconstruction using perforator free flaps. Material and Methods: A series of 42 patients underwent this procedure between February 1996 and September 2001. Average age was 49 years (26-71 yr). Seventeen patients (41%) had one or more risk factors (smoking, radiotherapy, chemotherapy, etc…). Family history of breast cancer was reported in 21 patients (50%). Results: Primary and secondary bilateral breast reconstructions were done in 16 and 3 patients respectively. Fifteen patients, who had had breast reconstruction with implant, had a tertiary breast reconstruction. Combined reconstruction (primary with secondary and primary with tertiary reconstruction) was done in 8 patients. 76 Deep inferior epigastric perforator DIEP flaps and 8 superior gluteal artery perforator S-GAP flaps were used. Simultaneous bilateral breast reconstruction was performed in all patients with DIEP flap (38 patients) and in one patient with S-GAP flap. In three patients, a differed breast reconstruction was done using S-GAP flap with 6 months interval. Average operative time was 10.5 hours (8-14.5 hours) for the simultaneous bilateral reconstruction. Total necrosis occurred in one case of DIEP flap and the reconstruction was salvaged with SGAP free flap 6 months later. Two pulmonary infections, one DVT and one cardiac arrhythmia were reported as postoperative complications. Mean hospital stay was 9 days (range 6-20 days). An abdominal bulging was reported in one patient. There were no recurrent disease or cancer manifestations, with an average follow-up of 3 years. Conclusions: Decreasing the donor site morbidity and offering an excellent aesthetic and long-term outcome by using this technique provides a high rate of patient satisfaction and is an adequate oncological alternative.