Breast Reconstruction - Free Flaps: Case 2 - Bilateral DIEP Flaps This is a 43-year-old woman with a family history of breast cancer, who was found to have the BRCA-1 genetic mutation. She decided to undergo bilateral prophylactic mastectomies and immediate breast reconstruction with DIEP flaps. Because she did not have nipple sparing surgery, she returned for a second stage procedure at which time she underwent nipple reconstruction as well as minor revisions to improve her breast shape. Once healed, nipple areola tattoos were accomplished in the office. The mastectomies were completed with incisions around each nipple areola, allowing removal of her breast tissue while preserving her breast skin. Each nipple was reconstructed from the healed DIEP flap skin on each reconstructed breast. This was ambulatory surgery with a relatively quick recovery. The final photo shows her appearance after her bilateral nipple tattoo, once she was fully healed from all stages of reconstruction.