The gluteal artery perforator flap (GAP) represents the state of the art in autologous breast reconstruction for the patient with inadequate abdominal soft tissue volume or prior abdominal surgeries that render the abdomen a nonviable source of donor tissue. Preservation of gluteal musculature substantially limits morbidity and allows for rapid patient recovery. The need for intraoperative repositioning has historically limited GAP flap breast reconstruction to one breast per operation. This results from a desire to avoid marathon surgical times when the flaps are dissected out sequentially and/or having the patient lie on the first reconstructed breast as the second flap is harvested. Prior protocols have relied on staging the reconstructions days or weeks apart to address these concerns. This is a significant issue for patients requiring bilateral mastectomy. The result is the patient being subjected two major operations, two general anesthetics, two recoveries, and two sets of hospital charges. Our group has recently developed a protocol to provide bilateral immediate simultaneous GAP flap reconstruction for our patients. We describe our experience and associated technical considerations with an initial 8 patients (16 flaps). Average surgical time was 7 hours (depending on whether immediate nipple reconstruction was included). Hospital stay was an average of 4 days and there were no take-backs or flap failures. This represents the largest described experience to date with bilateral simultaneous GAP flap breast reconstruction. Our protocol provides significant advantages and an option that has heretofore been unavailable to this group of patients