Patient 136 Gallery

Before and after bilateral breast revision in a 72 year old breast cancer survivor.  She was 4 years out from her bilateral mastectomies and implant reconstructions and had sought a revision elsewhere which she felt just made things worse.  Unfortunately, we see countless women like this who have had past breast surgery and are just looking ”to look normal again”.

In this woman’s case, her breast scars were riding high up her chest, and both of her implants which were under the muscle had “bottomed out” and slid down her chest.  

Both inframammary folds had been disrupted, which prevented her from wearing a bra.  She reported that when she raised her arms, both mounds would slide out of her bra since there was no fold for her bra to grip onto underneath.  This is a very common complaint of women who require inframammary fold reconstruction.

She had been told that she had had a nipple sparing mastectomy, but she couldn’t find her nipples anywhere!   We found them and marked them as shown in her before images taken from the side diagonal.

Unfortunately, when a lateral incision is used for the mastectomy (to the side of the nipples), it pulls the nipple to the side into a non-anatomic position.  Moving her nipples to a more normal location would require removal as free nipple-areola grafts and replacement on the breast reconstruction into a more normal location, since they were pulled so far to the side by her past surgery.  

Her breast revision involved removal of her previously placed shaped, textured implants which had “malrotated” into an unusual position on the chest, lying at 90 degrees to where they should be in their pocket.  The textured surface acts like Velcro and keeps them in this position, and creates an extremely hard result.

Previously placed acellular dermal matrix (ADM) which was floating next to the implant but had not healed was removed and discarded.  Like any medical product or device, there is a place for ADM but it is not something I use in my practice. I remove much more unincorporated ADM (failure to heal) or infected product from other surgeons than I have ever put in myself.  

Her inframammary folds (IMFs) and the outer boundary of the breasts were reconstructed by long acting (but not permanent) sutures that recreated the fold under her breast.  These sutures must be inserted from the undersurface of the skin to the lining over the ribs, known as the “perichondrium”. Some temporary discomfort is expected as this lining has multiple nerve endings that become irritated after IMF reconstruction.  

New smooth round silicone gel breast implants were placed on top of the muscle, after the muscle was separated from the undersurface of the breast skin and returned to the chest wall, where it belongs!  Excess fat was removed from the upper part of her chest, in the abnormal collection under her breasts and her back fat/bra roll area via liposuction.

Her nipples and areolas were removed from their abnormal location (too low and too far to the sides) and placed in a more normal location on the breast as free grafts.  Follow up photos are shown 6 months after surgery. She can finally wear a bra, and no longer feels “like a freak”. She still has some loose skin at the sides of her breasts, which is expected in your 70’s!  It is never too late to do a revision surgery. Improving quality of life, symmetry and aesthetics is what Plastic Surgery is all about.