Before and after bilateral breast reconstruction revision in a 32-year-old BRCA gene positive women. Her original reconstruction featured implants under the muscle, which caused chronic pain and tightness. She had also been left with significant asymmetry which made wearing a bra awkward and left her feeling lopsided.
The right implant sat up higher due to her right hand dominance and the muscle pulling the implant upward every time she moved her arm. The left implant sat lower due to violation of her inframammary fold at the time of her mastectomy and the implant sitting lower than her natural fold.
Her reconstruction revision involved removal of the old textured breast implants and replacing her pectoralis major muscles to the chest wall, resuturing them back to their original position on top of the ribs. A pocket was created on top of the muscle, in the prepectoral position.
New smooth round silicone gel breast implants were placed in the location where her breasts used to be, which we feel is the most sensible and natural way to reconstruct the breast! She wished to be a little smaller, so a lower volume and less projecting implant was selected, based on the patient’s “wish pictures” she brought to her in-person preoperative visit.
The left inframammary fold was reconstructed with an “internal bra” resorbable biological mesh that was made of “P4HB”. This helped to create a new fold and provide stability to the implant, since past suture-only techniques had failed. Lastly, liposuction removed excess fat from her armpits to complete her aesthetic breast reconstruction revision.
Long-term follow up photos are shown 4 years after surgery, with a stable breast reconstruction result and a much more comfortable patient.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
