Fig. 3.

Group 3 patient. A, Patient following mastectomy and radiation therapy and no breast reconstruction. B, The breast footprint is marked. The upper mastectomy flap is elevated, and the lower mastectomy flap is deepithelialized to preserve maximum volume for the breast reconstruction. C, Following delayed right breast reconstruction with DIEP flap and left mastectomy and immediate breast reconstruction with DIEP flap. Although the abdominal tissue was divided eccentrically to achieve greater symmetry, some asymmetry persists. D, Following bilateral nipple reconstruction and fat grafting to further improve breast symmetry. E, F, Lateral photographs demonstrate breast projection optimized with preservation of lower mastectomy flap volume, eccentric distribution of DIEP flap tissues, and fat grafting.