61 yo who underwent bilateral subcutaneous mastectomies and immediate breast reconstruction with silicone implants 21 years earlier. The patient developed hare, painful capsular contractures. The implants and capsules were removed and she was reconstructed with bilateral microvascular muscle sparing free TRAM flaps. Note the natural appearance of the reconstructed breasts. Photographs taken 2 years later. Patient can now move breast close together at the cleavage area, when previously the breast were fixed to the chest wall because of the capsular contracture.