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This patient presented after left mastectomy and radiation.  She desired a right preventative mastectomy and reconstruction of both breasts to the same or larger volume.  To do this, a surgical delay of a DIEP flap on the right and SIEA flap on the left was performed.  The delay technique is a short operation performed to eliminate competing blood supply the DIEP or SIEA vessel, allowing the source vessel to dilate and supply tissue beyond it’s normal distribution.  This allowed for additional tissue on the patient’s side to be carried with the flap and reduced the chance of fat necrosis.  The flaps were transferred after two weeks and an additional small implant was added for final volume.  She will undergo final left nipple reconstruction to complete here result.  Knowledge of this patient’s unique anatomy was the result of planning, preoperative imaging and an expert radiology team in addition to the patient’s input and preferences.

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