The Rectus Peg Flap	An ipsilateral pedicle is used.	Transfer of the Rectus 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 Rectus Peg Flap	The Bowtie nipple-areolar flap is raised within the Rectus Peg Flap	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 and recreates the projection of the nipple-areolar complex	The wings of the bowtie are rotated under the semicircular flap.	Closure of the Bowtie flap creates the nipple
Excessive suturing of the bowtie flap is avoided.	The outer border of the areola is inscribed with a circular template	A 4.2 circular template is used.
The incision at the outer border of the areola	The excess skin of the Rectus Peg Flap is removed	The specific geometry of the nipple-areolar complex 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	Divergent shaped Bowtie Flap will result in a more conical areolar contour	A divergent shaped Bowtie Flap that is curved
A Rectus Peg Flap is elevated from the abdomen	A Rectus Peg Flap is rotated in clockwise direction for the right breast and a counter clockwise direction for the left breast. Poorly perfused portions of the flap will be resected prior to transfer.	Preoperative Ductal carcinoma of the right breast
2 months postoperative after mastectomy with a Rectus Peg Flap reconstruction and a bilateral repositioning. The surgery was completed in a single procedure. The nipple-areolar complex was subsequently pigmented.	Preoperative Ductal carcinoma of the right breast	3 months postoperative after mastectomy with a Rectus Peg Flap reconstruction and a bilateral repositioning. The surgery was completed in a single procedure. The nipple-areolar complex has been pigmented.

Immediate Autologous Reconstruction with the Latissimus Dorsi Peg Flap

Delayed Autologous Reconstruction with Rectus and Latissimus Dorsi Peg Flaps