A novel two-step reconstruction scheme using a combined near-infrared and ultrasound technique and its utility in imaging distributions of optical absorption and hemoglobin concentration of breast lesions are demonstrated. In the first-step image reconstruction, the entire tissue volume is segmented based on initial coregistered ultrasound measurements into lesion and background regions. Reconstruction is performed by use of a finer grid for lesion region and a coarse grid for the background tissue. As a result, the total number of voxels with unknown absorption can be maintained on the same order of total measurements, and the matrix with unknown total absorption distribution is appropriately scaled for inversion. In the second step, image reconstruction is refined by optimization of lesion parameters measured from ultrasound images. It is shown that detailed distributions of wavelength-dependent absorption and hemoglobin concentration of breast carcinoma can be obtained with the new reconstruction scheme.Tumor blood volume and microvascular density are parameters that are anatomically and functionally associated with tumor angiogenesis. During the past decade, modeling of light propagation in the near-infrared (NIR) region, combined with advancements of light source and detectors, has improved diffused light measurements and made possible the application of tomographic techniques for characterizing and imaging tumor angiogenesis. 1,2 However, the NIR technique has not been widely used in clinics, and the fundamental problem of intense light scattering remains. As a result, diffusive light probes a widespread region instead of providing information along a straight line, and tomographic image reconstruction is, in general, underdetermined and ill-posed. Zhu et al. 3 and Chen et al. 4 demonstrated a combined imaging technique, using a priori lesion structure information provided by coregistered ultrasound images to assist NIR imaging reconstruction in phantom studies. 3,4 As a result, the NIR image reconstruction is well defined and less sensitive to noise. In this Letter we report on our novel two-step image reconstruction scheme that uses the combined approach and demonstrate its utility in imaging tumor absorption and hemoglobin distributions. It is shown that detailed heterogeneous distributions of wavelength-dependent optical absorption and hemoglobin concentration of a breast carcinoma can be obtained. To the best of our knowledge, such detailed distributions have not been reported in the literature.