Before and after bilateral DIEP flap breast reconstruction in a 34-year-old breast cancer survivor. After having a double mastectomy for invasive breast cancer, tissue expander reconstruction, chemotherapy and left chest wall radiation, she sought to have a better looking breast reconstruction result.
Thankfully, she had enough lower abdominal skin and fat to use for microvascular reconstruction. Her long-term goal was to restore the former size and shape of her natural breasts, which were full and had good projection. A two-stage reconstruction was planned: free flaps to bring healthy, living soft tissue to the chest, followed by implants placed under the flaps for additional volume and projection.
Skin and fat was transplanted from her lower abdomen to her chest by disconnecting and then reconnecting the deep inferior epigastric artery perforator and two accompanying veins from the abdomen to the chest. Six months later, smooth round silicone gel breast implants were placed under the flaps but on top of the pectoralis major muscles, in the prepectoral position.
At the same outpatient procedure, nipple reconstruction was performed using the local flap technique. Medical tattoo created new areolar circles. Liposuction and fat grafting improved the contour of her abdomen, hips and thighs, and added additional upper pole volume to her breast reconstructions.
Follow up photos are shown 1 year after surgery. She has achieved her goals and feels able to move forward with her career, with her breast cancer experience in the rear view mirror.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
