Patient 110 Gallery

Before and after left sided mastectomy and immediate DIEP flap breast reconstruction in a 42 year old woman.  Her nipple and areola was low and her breasts were pendulous, even more so on the left side where her breast cancer was located.  Like many DIEP flap patients, she wanted a natural breast reconstruction without the use of implants.

The plan to keep her left nipple and areola was to remove it at the beginning of her combined mastectomy and breast reconstruction surgery as a free nipple and areola graft.  Her mastectomy surgeon removed the breast tissue through a breast lift incision.

A DIEP flap was elevated and microsurgically transplanted to her left chest by disconnecting and then reconnecting the deep inferior epigastric artery and veins, together with a superficial epigastric vein from the flap that was “anastomosed” (microvascularly reconnected) to a vein in her “axilla” (armpit region).  

Her left nipple and areola was reattached as a free graft at the end of the procedure.  This way the nipple and areola was saved, since it was not involved with her breast cancer, and a breast lift was achieved at the same time.  Her right breast was lifted via a mastopexy at the same procedure.

Follow up photos are shown 9 months after surgery.  Her left breast reconstruction required radiation therapy after surgery, which begin at 6 weeks postop.  Radiation will not harm or “kill” a healthy DIEP flap; instead it will cause it to shrink slightly and for the nipple and areola position to be slightly higher after surgery.  

If it is known that radiation will be required prior to the mastectomy and breast reconstruction, the reconstructed nipple will be placed slightly lower than the other side to allow for slight shrinkage and nipple elevation after radiation.  In this case, it was not expected and the radiated nipple ended up slightly higher. While it did not bother this patient, a redo lift of her right breast was offered as a solution to lift up her right nipple to match the left.

In this case, postoperative radiation also caused “hypopigmentation” (lighter color) of the left nipple and areola graft.  It can be pigmented slightly darker if desired via medical tattoo in the office at a later date. This patient was very happy with her results and wanted instead to get back to being an active Mom!