38 yo after bilateral mastectomy without reconstruction in the past. She has had radiation to her right breast. Radiation typically leads to progressive, long term asymmetry regardless of the type of reconstruction technique used. Still, using your own tissue to reconstruct the breast can help mitigate this. She has had bilateral deep inferior epigastric perforator flaps to reconstruct the breasts. In this procedure, skin and fat from the abdomen is transplanted to the breast via microsurgical technique. The abdominal muscles are left behind, unlike TRAM surgery. Complications of this surgery include abdominal bulging, which can be slight as you see here, or more severe requiring corrective surgery. As healing, and scarring happens, sometimes the belly button can shift away from the midline. This patient is 28 months after bilateral DIEP and has had surgical nipple reconstruction and tattoo of the areola.