Patient with a right breast cancer who had an initial periareolar biopsy incision.	Periareolar breast biopsy incisions. An initial breast biopsy with a periareolar incision will allow a skin-sparing mastectomy.	The circular opening that is created from a skin-sparing mastectomy. This type of mastectomy removes the remaining breast tissue including the nipple and areola. Removal of the nipple and areola is required because it contains a significant amount of breast tissue.
A skin–sparing mastectomy allows a Peg Flap reconstruction with a single operation. The Peg flap is placed into the circular opening of the skin sparing mastectomy.	The circular Peg Flap is then used to create the nipple. Mastectomy and reconstruction including the creation of the new nipple is performed in a single operation. The mastectomy scar is hidden around the border of the newly created nipple.	10 days after a right mastectomy with a Peg Flap reconstruction. The entire surgery was completed in a single operation. Small sutures around the newly created nipple were removed on this day. The nipple was pigmented one month later.
Another patient before surgery. A right breast biopsy incision is present.	Two months after right mastectomy and Peg Flap reconstruction, before pigmentation of the nipple.	Three months after right mastectomy with Peg flap reconstruction. The nipple has been pigmented.
Another patient before surgery. The circular incision of a skin-sparing mastectomy is highlighted on the right breast.	Two months after mastectomy and reconstruction of the right breast with a Peg flap. The surgery was performed in a single operation.	Two months after mastectomy and reconstruction of the right breast with a Peg flap. The surgery was performed in a single operation.
Another patient before surgery. A right periareolar breast biopsy incision is present.	Two months after right mastectomy and Peg flap reconstruction with uplift of both breasts. The surgery was performed in a single operation.
Another patient with a right breast cancer.	Three months after right mastectomy with Rectus Peg flap reconstruction. The surgery was performed in a single operation. The nipple has been pigmented.
Before mastectomy and Peg flap reconstruction of the right breast.	Two months after surgery. This patient has had a single operation with a skin-sparing mastectomy and a Rectus Peg flap. Both breasts were uplifted. The newly created nipple will be pigmented to match the opposite breast.
Another patient before surgery. The circular incision of a skin-sparing mastectomy is highlighted on the right breast.	Two months after mastectomy and Peg flap reconstruction in a single operation. The nipple has been pigmented. Surgery was performed in 1991.

Delayed Breast Reconstruction with a Peg Flap

One year following a mastectomy. The right breast was reconstructed with a Peg flap.

Two months after reconstruction with a Peg flap.

Four months after reconstruction with a Peg flap. The nipple was pigmented one month later.

Pectoralis Peg with Bowtie Nipple-Areolar Reconstruction
Breast reconstruction without a flap

Periareolar breast biopsy incisions. For either an implant or flap rconstruction, an initial periareolar breast biopsy incision is needed for a skin-sparing mastectomy	The circular incision of a skin-sparing mastectomy.	The circular opening that is created from a skin-sparing mastectomy. This type of mastectomy removes the remaining breast tissue including the nipple and areola. Removal of the nipple and areola is required because it contains a significant amount of breast tissue.
A breast expander is either placed at the time of mastectomy or when the patient decides upon breast reconstuction. The valve in the center of the expander allows the addition of fluid after surgery.	Closure of the circular opening of a skin-sparing mastectomy results in a smaller scar.	Immediately after a mastectomy with placement of a breast expander under the pectoral muscle.
During an expansion, a small needle is inserted through the breast skin into the valve of the expander. Sensation is diminished during the inflation period that stretches the breast skin.	More stretching of the breast skin is needed before creation of the nipple if a modified radical mastectomy was performed during the first operation.	Two months after a mastectomy with complete inflation of a breast expander.
Growth of new vessels into the remaining breast skin during the inflation period between the first and second operations.	The relationship of a skin-sparing mastectomy scar with the Bowtie incision. Creation of the nipple and areola will cover the mastectomy scar.	The left breast is completely expanded before the Pectoralis Peg with Bowtie nipple-areolar reconstruction.
The relationship of a skin-sparing mastectomy scar with the Bowtie incision. The neovascular territory of the Pectoralis Peg is represented in the diagram. Small vessels from the muscle grow into the breast skin.	Within the neovascular territory of the Pectoralis Peg, the Bowtie Flap is raised full thickness with a central pedicle (circulation) of Pectoralis muscle and scar capsule that forms around the expander.	A completed Pectoralis Peg with Bowtie nipple-areolar reconstruction.
Same patient, six weeks after surgery. The nipple was pigmented two weeks later.	Same patient, two months after surgery. The nipple has been pigmented.
Another patient, two months after Pectoralis Peg with Bowtie nipple-areolar reconstruction.	Same patient, two months after Pectoralis Peg with Bowtie nipple-areolar reconstruction.

Previous methods of breast reconstruction