Before and after bilateral nipple-sparing mastectomies and immediate single-stage implant reconstruction in a 38 year old BRCA gene positive woman. She had a significant history of breast cancer in her family and she had finished having her children.
She had a previous submuscular breast augmentation with capsular contracture and significant drooping of her nipples, with an elongated breast shape. She wished to be reconstructed as full as her preoperative size, with a very round upper pole. A lift of her nipples and reduction of her areola diameter was recommended for the most aesthetic results.
Preoperatively, she demonstrates the “Snoopy deformity” or “waterfall deformity” which is very common with submuscular breast augmentation – the muscle pulls the implant upward and breast tissue “falls off the implant” with an unnatural and unattractive look.
Bilateral mastectomies were performed and her old implants were removed. Her pectoralis major muscles were repaired to her chest wall. Her nipples and areolas were saved as free grafts, to be reapplied in a higher position at this end of this surgery.
Smooth, round postoperatively adjustable breast implants were placed in the pre-pectoral position, on top of the muscle. They were inflated to 90% of their final fill volume at the time of reconstruction. Her nipples and areolas were sewn back in place in a more youthful position.
Follow up images are shown at one month after surgery. There is still some mild bruising visible. She had one additional fill of 100 cc at two weeks postoperatively for her final reconstruction result. She is happy with the saline implants and understands she has the option to change her saline implants out for silicone if she wishes in the future. Her implant ports will be removed at three months after surgery.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
