Remy

PROCEDURES

Latissimus dorsi (LD) flaps | Expander-implant | Fat grafting | Nipple areola tattooing

Case Overview

Remy presented for bilateral mastectomies and chose to undergo immediate breast reconstruction with latissimus dorsi (LD) flaps and expander-implants. Her breast reconstruction required four stages in total, including fat grafting and nipple areola tattooing.

Surgeon

Ron Israeli, M.D.

Before

After

Before Stage One

Preoperative markings for bilateral mastectomies and latissimus flaps

These images show preoperative markings on her body before her first surgery. Remy’s first stage included bilateral skin-sparing mastectomies, expander-implant placement, and latissimus dorsi flap breast reconstruction.

The markings on her back indicate the donor site for the natural tissue portion of her breast reconstruction. Each flap includes an oblique crescent of skin. This allows a surgeon to use a circular skin island to reconstruct the nipple and areola.

Illustration showing stage one of breast reconstruction using latissimus dorsi flaps. The first panel shows preoperative markings on the back for bilateral latissimus dorsi muscle flaps. The middle panel shows the transfer of the latissimus dorsi muscle and skin to the chest with a tissue expander placed underneath. The final panel shows the back after the muscles and skin have been transferred and the donor sites closed.

Three Months After Stage One

Preoperative markings for bilateral tissue expander implant exchange

This is Remy before the second stage of her breast reconstruction, three months after the first stage. These presurgical markings are part of her team’s preparation for bilateral tissue expander implant exchanges. Her final implants were placed during the procedure that followed these images.

Three Months After Stage Two

These images show Remy three months after her final breast implants were placed. The photos were taken directly before a third stage procedure that included bilateral nipple areola reconstructions and fat grafting to soften the appearance of the upper edges of her implants.

Illustration showing stage two of reconstruction with implant exchange. The first panel shows preoperative markings around the tissue expanders. The middle panel shows removal of skin around the expander sites and placement of permanent bilateral implants. The final panel shows the breasts after skin closure from the stage two procedure.

Three Months After Stage Three

This is Remy three months after bilateral nipple areola reconstructions and fat grafting. Her surgeon used the modified skate-flap purse string technique to reconstruct her nipples.

Illustration showing stage three of breast reconstruction. The first panel shows preoperative markings for nipple-areola reconstruction and fat grafting. The middle panels show step-by-step nipple-areola reconstruction using the modified skate-flap purse-string technique. The final panel shows the reconstructed nipples and breasts before nipple tattooing.

One Year After Stage One

After Nipple Areola Tattoo (Stage Four)

These images show Remy exactly one year after her mastectomies and initial expander-implant breast reconstruction. Donor site images show her healed latissimus dorsi flap scar. Her latissimus dorsi flap was designed such that the final scar would heal in an oblique orientation. This scar placement helps the scar to fade in the months after surgery.

At this point, Remy was fully healed from all three surgeries. She underwent nipple areola tattooing to add more natural color to her reconstructed nipples.

Last updated on July 15, 2026

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