This 45 year old woman had undergone a right breast reduction and left TRAM flap – both that mostly failed. Her very scarred situation required new tissue. Bilateral latissimus dorsi flaps taken from her back supplied new breast skin and fat, and moderate sized implants supplied volume. Her mid-line ventral abdominal hernia from the previous TRAM was repaired. She has lost 30 pounds since then and is very healthy.