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

Case Overview

Joanne 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.

Dr. Israeli


Ron Israeli, M.D.

women's breasts
women's breasts

Before Stage One

Preoperative markings for bilateral mastectomies and latissimus flaps

These images show preoperative markings on her body before her first surgery. Joanne’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.

Three Months After Stage One
Preoperative markings for bilateral tissue expander implant exchange
This is Joanne 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 Joanne 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.

Three Months After Stage Three

This is Joanne three months after bilateral nipple areola reconstructions and fat grafting. Her surgeon used the modified skate-flap purse string technique to reconstruct her nipples.
One Year After Stage One
After Nipple Areola Tattoo (Stage Four)
These images show Joanne 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, Joanne was fully healed from all three surgeries. She underwent nipple areola tattooing to add more natural color to her reconstructed nipples.