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Before and after bilateral prophylactic nipple sparing mastectomies and combined DIEP flap and implant breast reconstructions. This 37 year old woman learned she was positive for the BRCA gene and elected to finish having her children before undergoing risk reducing mastectomy surgery and breast reconstruction.

She wanted to use her own tissue for reconstruction with a final aesthetic goal of being fuller than her current breast size, similar to when she was breast feeding. A two stage procedure was planned, with DIEP flaps to be transplanted at the time of her mastectomies and a later breast implant under the flap.

Nipple sparing mastectomies were designed using a breast lift pattern. Her nipples and areolas were saved and reapplied higher up on the breast as free nipple-areola complex grafts. Six months later, smooth round silicone gel breast implants were placed on top of the muscle, underneath the DIEP flaps – this is similar to a subglandular breast augmentation.

Follow up photos are shown 3 months after her second stage procedure and 9 months after her DIEP flaps. Our patients’ aesthetic goals for their breast reconstruction become OUR goals – and all surgery stages are covered by insurance, by law!

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*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.

Dr Karen Horton