Free muscle sparing TRAM flap / creation of nipple & tattooing of areolar complex. 54 yo with left breast cancer who had undergone previous lumpectomy and radiation for DCIS (very early stage breast cancer) and on follow up mammograms was noted to have microcalcifications that were positive for invasive breast cancer. Therefore she underwent a completion left mastectomy with same time pedicled TRAM flap reconstruction and right breast symmetrizing reduction. Three year follow up photos post creation of the left nipple and tattooing.