Case-28959 Gallery

Before and after bilateral breast reconstruction revision in a 53 year old breast cancer survivor. Over 15 years ago, she underwent a left non-nipple-sparing mastectomy and chemotherapy for breast cancer. Her left submuscular implant was tight, limiting her upper body movement and limiting her physical activities – especially since she was left-handed. She had a balancing implant on the right that was also under the muscle. Her animation deformity is impressive on both sides. She previously had a free nipple graft from the right breast to the left, but it lay higher than the right nipple and contributed to her asymmetry.

Her breast revision involved removing the old implants, separating and replacing her pectoralis major muscles to the chest wall, recreating a new space for an implant on top of the muscle (prepectoral on the left, subglandular on the right), and insertion of a new smooth round silicone gel breast implant on each side.

Liposuction of the axillary rolls helped to contour her armpits. It is common for a normal amount of axillary fat to appear more prominent following an aggressive mastectomy, since the normal transition from the axillary tail of fat/breast tissue to the remainder of the breast is disrupted. We always recommend liposuction here to smooth out this sharp transition after mastectomies.

A small amount of free fat graft was added to the upper pole of the left breast, but in very thin mastectomy skin flaps like hers, very little of the fat graft survived. Fat grafting is not magic. The “donor site” will benefit (where we take the fat from), but we cannot expect a majority of the fat to survive when injecting it to an area of very thin skin.

The left nipple reconstruction was regrafted lower on the left breast, and tattoo reconstructed a left areolar circle. The right areola was also tattooed for symmetry. Her surgery took three hours and she was discharged later that day.

Follow up photos are shown 9 months after surgery. Her golf and tennis swing improved immediately after she was allowed to return to the course/court (at one month postop). Her bright areola tattoo will fade and look even more natural over the next several years.