45 yo with multifocal ductal carcinoma in situ of the right breast. Lumpectomy failed to obtain clear margins and the patient elected to have a right mastectomy and prophylactic left mastectomy. Breast reconstruction was performed at the same time with bilateral muscle sparing free microvascular TRAM flaps. Five months later she underwent nipple and areolar reconstruction and later tattooing. Photos are taken 3 years after reconstruction.