Case-10331 Gallery

Before and after right skin and areola sparing mastectomy and immediate reconstruction using the deep inferior epigastric artery perforator (DIEP) flap in a 36 year old woman with aggressive breast cancer. She completed neoadjuvant chemotherapy prior to having her mastectomy. Her nipple was removed on the right but her areola was preserved.

Her right breast was reconstructed using a DIEP flap. She knew she likely needed radiation therapy and so the flap was designed slightly larger than needed by approximately 10-20%. Radiation therapy will not injure a flap; instead, it causes mild shrinking of the tissue (which I describe like putting a wet wool sock in the dryer on high – even if for just a few minutes, it will shrink subtly).

She had enough tummy fat to be reconstructed slightly larger than her postpartum deflated breast size, which was her goal. Her left breast was augmented with an adjustable saline implant at the same procedure together with a lift of the nipple and areola. After surgery, she underwent radiation therapy and is now completing additional chemotherapy.

Follow up photos are shown 3 months after radiation therapy to her right chest wall was completed. Her right chest wall and breast skin is still slightly darker due to the radiation. Her reconstruction has good symmetry and her breasts are fuller. Her tummy is FLAT! Her scars are maturing and she still has the port from the adjustable saline implant on the left in place, to adjust the implant volume if necessary if the right DIEP flap volume changes after radiation.

We plan to return to the operating room once she has completed her additional chemotherapy to remove the implant port and possibly change her implant from saline to silicone (this is optional, and her decision based on the look and feel of the implant). We will perform some free fat grafting to the right DIEP flap, which will benefit her donor site and remove additional unwanted fat from other parts of her body (completing her breast cancer Mommy Makeover!).

Her last surgery will also include a right nipple reconstruction. This will be done by “nipple sharing”, which takes a piece of the left nipple and grafts it to the right side. The “donor nipple” will retain sensation and ends up around 50% smaller; the recipient nipple will heal well, even in a radiated field, and usually looks just like the nipple was saved!