Free muscle sparing TRAM flap / creation of nipple and tattooing of nipple areolar complex. 39 yo 5′ 6″ with a upper outer quadrant left breast cancer who underwent skin sparing mastectomy and same time muscle sparing free TRAM flap reconstruction. Patient had a previous laparotomy (abdominal surgery) hence the scar. Second stage – patient underwent creation of the nipple and tattooing of the nipple and areolar complex. Note body proportions and breast symmetry and contour post reconstruction. The abdominal incisions have healed well and the abdominal wall muscular integrity is ensured with an in lay and an on lay mesh repair of the donor site.