The Latissimus Dorsi Peg Flap	A partition of subcutaneous tissue (indicated in blue) separates the mastectomy from the flap donor site of the Latissimus Dorsi	Transfer of the Latissimus Dorsi Peg Flap to the breast
Incision for a skin preservation mastectomy	Careful sharp dissection of the breast skin during mastectomy	The intraoperative defect of a skin-sparing mastectomy prior to the insertion of a Peg Flap
The Bowtie nipple-areolar incision within the Latissimus Dorsi Peg	The Bowtie nipple-areolar flap is raised within a Latissimus Dorsi Peg	The donor site for the Bowtie nipple-areolar flap is directly closed
Direct closure of the donor site avoids a skin graft for the areola	The rectangular flaps are rotated under the semi-circular flap	Excessive suturing of the bowtie flap is avoided.
Closure of the Bowtie flap creates the nipple	The outer border of the areola is inscribed with a circular template	A 3.8 or a 4.2 cm. circular template is used.
The incision at the outer border of the areola	The excess skin of the Latissimus Dorsi Peg Flap is removed	A Bowtie nipple areola on a latissimus Dorsi Peg Flap before transfer to the left breast
The dog ear redundancy of the Bowtie nipple–areolar is corrected with flap elevation	Flap elevation of the entire latissimus Dorsi including subcutaneous fat overlying the muscle	The bowtie nipple-areolar reconstruction within a Latissimus Dorsi Peg Flap
Transfer of the Latissimus Dorsi Peg flap into the skin–sparing mastectomy defect in a single stage. The Bowtie nipple-areolar complex was created at the donor site	Projection of the nipple-areolar complex of a Peg Flap is created by the specific geometry of the Bowtie flap	The specific geometry can be modified by changing the shape of the bowtie flap.
A rectangular shaped Bowtie Flap will result in a flatter areolar contour	The width of the Bowtie flap determines the height of the nipple	A divergent shaped Bowtie Flap will result in a conical areolar contour
A divergent shaped Bowtie Flap that is curved	Mastectomy and reconstruction performed in a single procedure with a Latissimus Dorsi Peg Flap	2 weeks after a single stage mastectomy with a Peg Flap reconstruction
2 months after mastectomy and reconstruction with a Peg Flap	Preoperative Ductal carcinoma of the right breast	Two months after mastectomy and reconstruction of the right breast with a Latissimus Dorsi Peg Flap. A minor repositioning of the left breast was also performed concurrently
Periareolar biopsy of the left breast before mastectomy and reconstruction	2 months after mastectomy and Peg flap reconstruction of the left breast	2 months after mastectomy and Peg Flap reconstruction of the left breast
The flap donor site scar after a Latissimus Dorsi Peg flap	Preoperative Right ductal breast cancer	Two months after right mastectomy with Latissimus Dorsi Peg Flap reconstruction and before pigmentation of the nipple
12 months after right mastectomy with latissimus Dorsi Peg Flap reconstruction. A bilateral breast augmentation with pigmentation of the nipple has been performed	Flap donor incision on right back after Latissimus Dorsi Peg flap	A latissimus Dorsi Peg flap can be performed with either unilateral of bilateral repositioning. Repositioning incisions of the breast skin envelope of the mastectomy are vertically oriented
Symmetry of the incisions	Preoperative Ductal cancer of the right breast	Two months after right mastectomy and Peg Flap reconstruction with bilateral breast repositioning. The entire procedure was performed in a single operation.
Six months postoperative	Six months postoperative

Immediate Autologous Reconstruction with the Rectus Peg Flap

Delayed Autologous Reconstruction with Rectus and Latissimus Dorsi Peg Flaps