Case-10483 Gallery

Before and after revision breast surgery in a 52 year old BRCA gene positive woman. She had previously undergone bilateral prophylactic nipple sparing mastectomies and implant reconstruction. Her implants were under the muscle which created a severe flexion deformity whenever she used her upper body. Flexion of her pectoralis muscles over the implants flattened her breasts and created a deforming hollow around the implants. Her breasts did not “feel like part of my body” and she had considered having them removed altogether, having no breast reconstruction at all.

Although she spoke to her surgeon about this several times, she was told to “just stop doing things that cause your muscles to do that”. This included nearly all activities of daily living, and certainly yoga, tennis and golf, her favorite activities. This was NOT OKAY with her. (As it should be!). She sought another opinion.
She was a perfect candidate for a breast revision. She had healed from her mastectomies and her nipple and areola circulation was now stronger than before – this is called the “delay phenomenon” where the remaining circulation to the nipple becomes more robust after a mastectomy, since the only blood supply is now through the microcirculation under the breast skin.

Her chest wall anatomy was reconstructed by separating the muscles from the undersurface of her breast skin and returning her pectoralis major muscles to the chest wall. New cohesive silicone gel breast implants were placed on top of the muscle – this has been nicknamed the “pre-pectoral” position in the last few years. This has been the standard for all of my patients over the last 12 years.

Liposuction of the axillary rolls permanently removed fat from these areas, enhancing the cosmetic outcome of her reconstruction revision surgery. Follow up images are shown 3 weeks after surgery. In one more week she can return to full activities. Whereas her submuscular tissue expansion process was “horrifically painful”, she took Tylenol plain for 24 hours after this surgery and then stopped all pain medication altogether.

She feels much more natural and the muscle tightness and discomfort is gone. Her flexion deformity has been eliminated, as can be seen in the first set of before and after photos. It is not necessary in most situations to place implants under the muscle for breast reconstruction. Learn more about this technique in my blog post on this topic.