Patient 14 Gallery

Before and after bilateral prophylactic mastectomies and immediate implant reconstruction in a 41 year old BRCA gene positive woman. She was an obvious candidate for a breast reduction as well. Her goal was to be reconstructed smaller and perkier than her current size, which was out of proportion to her small frame.

Bilateral skin sparing mastectomies were performed through a breast reduction skin pattern. Her nipples and areolas were removed at the beginning of the mastectomies and reduced in size, but not thrown away! “Nipple sparing” mastectomy is still possible if the nipples are very low on the breasts – they are reapplied as free nipple-areola grafts at the end of her reconstruction surgery.

Smooth round adjustable saline implants were placed on top of the muscle, in the prepectoral position. No acellular dermal matrix (ADM) or other mesh products were used. Loose, excess skin was redraped around the implants to create a breast lift, the implants were fully inflated to her desired size on the table, and her nipples and areolas were reapplied in a higher position at the end of surgery.

She spent two nights in the hospital and resumed regular activities including holding her toddler and exercising at one month. The nipple dressings were removed at ten days, revealing 100% “take” or survival of her nipple-areola free grafts. No additional saline was injected after surgery. This truly was a single stage breast implant reconstruction!

Although the saline implants are permanent and only the remote injection dome needs removal three months later, most patients (like this one) choose to switch their implants from saline to silicone. Silicone gel breast implants have a variety of advantages of saline, including less ripping and a more natural look and feel. Learn about the latest and great breast implants used for breast reconstruction in this blog post.

The saline implants were exchanged for more cohesive silicone implants a year later as an outpatient procedure. Follow up photos are shown 6 months after this last surgery. Nipple and areola free grafts often heal with slightly less pigment like other skin grafts on the body. This pigment can be touched up by medical tattoo in the office as needed.