Incision for a skin preservation mastectomy	Careful sharp dissection of the breast skin during mastectomy	The defect created from a skin-sparing mastectomy
During a skin-sparing mastectomy	Immediately after a mastectomy with insertion of a breast expander	Two months after a mastectomy with complete inflation of a breast expander
Growth of new vessels from the pectoralis major	Neovascularization of the remaining breast skin	The relationship of a skin-sparing mastectomy scar with the Bowtie incision
The relationship of a skin-sparing mastectomy scar and the Bowtie incision within the neovascular territory of the Pectoralis Peg	Small neovascular perforators grow perpendicular to the skin surface	Creation of the nipple-areolar complex will cover a nondisplaced mastectomy scar
A rectangular shaped Bowtie flap will result in a flat 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	The left breast is fully expanded for the second stage Pectoralis peg with Bowtie nipple-areolar reconstruction	The Bowtie flap raised full thickness with a central pedicle of pectoralis and scar capsule
The semicircular flap is advanced to the top of the nipple	With the exception of irradiated skin, the circulation of the Bowtie flap is excellent	The removal of the expander and the replacement with the permanent implant is performed through the Bowtie incision
Adequate exposure is obtained through the Bowtie incision for modification of the implant pocket	Insertion of the permanent implant through the Bowtie incision	The permanent saline implant is inflated with a closed system
Preliminary closure of the Bowtie incision. Patient is then placed in a sitting position to judge symmetry	The nipple is created with the Bowtie flap	Closure of the Bowtie incision after achievement of volume symmetry
A 3.8 cm or 4.2 cm circular template is used to inscribe the areolar border	The inscribed areolar border. Closure of the bowtie incision has created a conical shaped areolar contour	The inscribed areolar border is incised
The adjacent breast skin is undermined	Irregular skin margins are conservatively excised	Purse string suture is inserted into breast skin margin
Purse string suture is drawn around the nipple-areolar complex	Closure and projection of the nipple-areola is achieved with the purse string suture	Nipple-areolar projection is achieved without compromising flap perfusion
A completed Pectoralis Peg with Bowtie nipple-areolar reconstruction	Two months after completion of left breast reconstruction with Pectoralis Peg	Two months after completion of left breast reconstruction with Pectoralis Peg
Breast expanded with a standard mastectomy scar	The neovasularization of the Pectoralis Peg with a standard mastectomy scar	The relationship of a standard mastectomy scar with the Bowtie incision within the Neovascular territory of the Pectoralis Peg
The Bowtie Flap Raised full thickness with an expanded central pedicle of Pectoralis and scar capsule	A typical deformity from a modified radical mastectomy with skin resection	After the first stage with insertion of the expander and repositioning of the left breast. The right breast has been fully expanded
Three months after completion of the right breast reconstruction. A Pectoralis Peg with Bowtie nipple-areolar reconstruction was performed	Three months after completion of the right breast reconstruction. A Pectoralis Peg with Bowtie nipple-areolar reconstruction was performed