Before and after breast revision in a 54-year-old breast cancer survivor. She had a prior mastopexy-augmentation before her breast cancer diagnosis. After healing from a left mastectomy and submuscular implant reconstruction, she sought improved symmetry.
Her left mastectomy skin was very thin, showing ripples of the implant that was too small for its space. She experienced tightness chronically and sharp pains every time she used her chest muscles. The pectoralis major muscles are not designed to be stretched out over breast implants! Conversion of submuscular implants to prepectoral is our most common reconstruction revision procedure for this reason.
Her revision involved removal of her old implants, replacing her pectoralis major muscle to the chest wall, and insertion of new smooth round silicone gel breast implants on top of the muscle. A wider and larger implant was inserted on the left in order to better match the right breast.
Since this patient was so thin and did not have enough donor site tissue for a flap, the left implant was wrapped with acellular dermal matrix (ADM). ADM is rarely used in our practice but was necessary in this case to try to add a few millimeters of thickness over the implant.
Free fat grafting attempted to add some additional volume over the implant, but since her mastectomy skin flap was so thin, it was not able to receive a significant amount of fat. The right breast was re-lifted by redoing the mastectomy incisions in order improve symmetry with the left more compact breast reconstruction.
Follow up photos are shown 7 months after surgery. Her animation deformity is gone, and she has the best possible symmetry, given her tissue quality.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
