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Breast reconstruction can be done in an immediate setting at the time of mastectomy or can be accomplished in a delayed setting after mastectomy. When an immediate breast reconstruction with flaps is to be performed it is important that the quality of the mastectomy flaps is considered. 

During the DIEP flap harvest, the skin and fat from the abdomen is isolated on its vascular pedicle and then brought up to the chest for microsurgical anastomosis. If the skin of the mastectomy is of questionable viability, the skin from the abdomen can be kept buried beneath the mastectomy skin until the viability of the mastectomy skin declares itself. 

The photograph demonstrates before and after bilateral mastectomy and immediate breast reconstruction with DIEP flaps. The mastectomy skin remained viable with excellent vascularity and yielded and excellent aesthetic result.