Description: 61 year old 5 foot 5 inch 148 lb female who previously had left mastectomy and needed radiation to the left chest wall. As a result she had left arm lymphedema and severe tightness across the chest wall. Note hyperpigmentation of radiated skin.

Description: Because of the radiation, this patient was not a good candidate for implants. With lymphedema, the latissimus dorsi flap was not a good option.

Description: To get as much abdominal tissue for reconstruction as possible, a muscle-sparing TRAM was performed, preserving more perforators and blood supply than could be achieved with a DIEP flap in this thin patient.

Description: To get symmetry with her native right side, a mastopexy (lift) was performed.

Description: Nipple reconstructed but not yet tattooed. Pictures 2 years after flap and 9 months after the nipple reconstruction.