Patient - Breast Reconstruction

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Before

This 49 year old woman had a family history of breast cancer and sought genetic screening for the BRCA breast cancer gene mutation. She was found to be positive for this. She had a mammogram which showed an abnormality in the right breast. A biopsy confirmed breast cancer. Her surgeon recommended bilateral mastectomies with sentinel node biopsies. She desired breast reconstruction Because of the large size of her breasts, the bilateral nature of the surgery, and her weight, which made her a high risk for reconstruction using her own tissues, I recommended immediate placement of tissue expanders followed by gel implants. I also suggested an incision patterned after a breast reduction and salvage of her nipples and areolae as grafts. 

After

She is shown 5 months after completion of her reconstruction. This was to have been a two stage process but she did undergo one additional procedure. After her mastectomies, she developed an area of full thickness skin loss under the left nipple from the injection of dye used to identify the lymph nodes in her left armpit. I had to debride this and used a triangular flap from below the breast to fill this in. She did very well from that. Her breasts are soft. Her implants are Mentor MemoryGel Xtra smooth, high profile, gel implants with a volume of 790 cc. Total time from first surgery to insertion of her implants: 4 months.