Before and after bilateral nipple-sparing mastectomies and immediate prepectoral implant reconstruction in a 57-year-old woman with submuscular saline breast implants and a recently diagnosed right breast cancer. After two lumpectomies with positive margins, she needs a completion mastectomy and chose to have both breasts removed.
She wanted to keep an implant for reconstruction but to have her new implants placed on top of the muscle. Bilateral nipple-sparing mastectomies were performed through an incision hidden in the fold of her breasts. Smooth round permanent postoperatively adjustable implants were placed in the prepectoral position, on top of the pectoralis major muscle. They were filled with saline so that she would be a little smaller than her augmented breast size.
The implant ports were removed three months later, and the patient chose to have her saline-filled breast implants exchanged for silicone gel. Her nipples were lifted through a crescentic incision around the top of each areola.
If her surgery had been performed today, she would have been offered free fat grafting (lipofilling) to try to add additional volume to her upper pole and conceal the edge of the implant and ripples that can be seen through her extremely thin skin. This surgery was done nearly twenty years ago.
Follow up photos are shown 3 years after surgery.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
