Patient in her 50’s.  Underwent right mastectommy for cancer.  Had a tissue expander placed, developed an infection and had to have it removed and replaced again later along with a left breast reduction.  Did not like the feel of the final reconstruction result with an implant. Underwent subsequent TRAM flap operation to remove the right breast implant and replace it with tissue from her stomach.  Final operation was fat grafting to the right breast, nipple areolar reconstruction, and revision of the abodominal scar.