*This 46 year old woman had bilateral mastectomies for a breast cancer. Her reconstructive surgeon suggested using her abdominal tissue to reconstruct her breasts. The surgical plan involved using a “muscle sparing free TRAM”. In other words, her abdominal tissue was harvested by dissecting the main artery and vein that give the tummy tissue its blood supply and then micro-surgically hooking the vessels up to an artery and vein in the patient’s chest wall. This allowed her to have a breast reconstruction using her own tissue but without losing her rectus muscles by removing the tummy tissue with the rectus muscles still attached (as is done when a “pedicle” TRAM flap is done). The first stage of her reconstruction was done at the time of her mastectomies, incorporated a breast reduction in the plan and was done as an in-patient. Some of her tummy skin replaced the nipple and areola temporarily. Approximately 6 months later the final breast shaping, scar revisions and nipple & areola reconstruction were done as an out patient. Six months following the final breast shaping, the nipple & areolas were tattooed by our cosmetic tattoo artist. The beauty of this procedure is that she was able to have her breasts reconstructed with her own tissue, had a breast reconstruction that was more in proportion to her body frame, and got a tummy tuck by default while keeping her rectus muscles intact. She is very pleased with her final result.