Patient 27 Gallery

Before and after combined DIEP flap, TUG flap and sub-flap breast implants in a 58 year old woman. She had previous mastectomies followed by chemotherapy, left sided radiation therapy and submuscular implant reconstructions. Her muscles were extremely tight over her implants and she was unable to exercise or perform many activities of daily living. She complained to her surgeon about chronic pain and dissatisfaction with her aesthetic results and was told “no you don’t have pain and you look fine”. She advocated for herself and sought another opinion!

The implants were removed and her muscles returned to her chest wall. Her muscles were very happy to be back in their correct anatomic position! A DIEP flap was used to reconstruct each breast. Her final aesthetic goal was to be close to her original breast size, which was greater than a DD cup size and was proportional to her curvy frame. Sub-flap implants were planned as a second stage procedure after she had healed for 6-12 months.

Due to severe radiation damage on her left side, she experienced a deep infection several months after surgery which required repeated debridements of infected radiated chest wall tissue. In order to replace volume that was lost from these surgeries, a TUG (inner thigh) flap was then transplanted over a year later to add additional volume to the left breast reconstruction. The TUG flap microsurgically transplants skin and fat the upper inner thigh to the left breast.

Next, breast implants were placed beneath the flaps in order to provide additional volume and projection to her breast reconstructions. Free fat grafting added some additional volume to her left chest wall and improved her abdominal and inner thigh donor sites.

Follow up photos are shown at one year after implant insertion under her flaps. Her DIEP flap abdominal donor site scar has matured well and her right upper thigh scar is barely noticeable. She is hesitant to have any more surgery, which is understandable given her long history of multiple surgeries and complications. She is considering having 3D tattooing to make a nipple and areola in my office sometime this year to complete her reconstruction.