Figure 4b. Skin thickening in a 41-year-old woman after TRAM flap reconstruction and radiation therapy. Sagittal T1-weighted (a) and T2-weighted (b) images of the reconstructed breast show radiation-induced skin thickening (large arrow), which appears as increased signal intensity in the dermal layer on the T2-weighted image (b). Note the fat necrosis in the superior breast (small arrow).