Case-33563 Gallery

Before and after bilateral breast reconstruction revision with liposuction of the axillary rolls in a 79-year-old healthy and active breast cancer survivor. She previously had bilateral mastectomies and implant reconstructions forty years previously, and had developed painful Grade IV capsular contracture, deformity, asymmetry and a significant animation deformity due to the under-the-muscle placement of her implants.

She exercised daily, took no medications and had no significant health issues, so it was reasonable to plan elective surgery even at the age of seventy-nine! Given the older generation of her implants and development of painful capsular contracture, intracapsular implant rupture was suspected. An MRI was not ordered since a total capsulectomy and implant exchange was our surgical plan from the outset – an MRI confirming implant rupture would not change our approach.

Her surgical revision involved reopening the incisions under her breasts, removal of the entire implant and its surround capsule as a whole (this is called “en bloc” capsulectomy) in order to avoid messiness intraoperatively due to old, ruptured silicone material, and replacing her pectoralis major muscles back down to the chest wall.

A new space was created on top of the muscle, in the prepectoral position. New smooth round silicone gel breast implants were placed prepectorally, and liposuction removed excess fat from her armpits and bra rolls.

Follow up photos are shown 2 years after surgery. She has less wide, less hard, no longer painful and more natural looking breast reconstructions. Her animation deformity was gone immediately upon awakening from surgery.

She is grateful that she was not considered “too old” for surgery, and that her current implants are covered under an implant warranty for twenty years. We will see her yearly in follow up going forward for a clinical examination, but she will not likely need any future surgeries.