Case-11537 Gallery

Before and after breast revision in a 33 year old BRCA gene positive woman.  She previously had bilateral nipple sparing mastectomies and a direct-to-implant reconstruction performed elsewhere, followed by placement of textured shaped implants that felt too firm and were completely immobile. 

She had a significant animation deformity that interfered with exercise and work.  She was looking for a more natural breast reconstruction with “breasts that move!” and a softer result, without the flexion deformity every time she moved her arms.  She felt her breasts were uneven and too big for her small, muscular frame. 

This patient had underlying chest wall asymmetry resulting from mild scoliosis.  Her sternum and ribs were more prominent on one side than the other.  This is quite common and was one of the factors contributing to her preoperative symmetry.  The right side of her chest protruded further out than the left, creating the appearance of a larger breast on the right.  Her left chest was in turn relatively sunken. 

The plan for surgery involved changing the plane of her implants from submuscular to subcutaneous and inserting different profile (projection) implants to help create better symmetry. 

Her inframammary fold scars were used to remove the textured implants, one of which had rotated 90 degrees, contributing to her deformity.  Her pectoralis major muscles were returned to the chest wall and her muscular anatomy was reconstructed. 

New smooth round silicone gel implants with intermediate stiffness or cohesivity (“SoftTouch”) were placed on top of the muscle, in the “prepectoral” plane.  A medium profile implant was used on the right side and a higher profile implant used on the left, with slightly more volume to make up the volumetric difference.  No additional products like mesh or ADM (acellular dermal matrix) were used.

Follow up photos are shown just 8 days after surgery.  She is avoiding exercising and using her muscles for a full month after surgery.  She had very little discomfort after surgery (a big change from all her surgeries involving muscles!).  She has just been taught implant massage and already loves her softer, mobile, more symmetric breasts.