Before and after bilateral nipple sparing mastectomies and immediate DIEP flap microvascular breast reconstruction in a 47 year old BRCA gene positive woman with breast cancer. She had large, pendulous and asymmetric breasts to begin with. She liked her breast size and wanted to remain proportional to her frame.
She was a candidate for a breast lift together with her breast reconstruction. She required neoadjuvant chemotherapy to shrink her tumor before surgery. After learning about all her options, she chose to use her own tissue from her abdomen to reconstruct her breasts.
Bilateral mastectomies were designed using a breast reduction pattern. Her nipples and areolas were saved and made slightly smaller. The ducts going into the nipple were removed and sent to the Pathology lab as a separate specimen to ensure no abnormal or cancerous cells were present in the nipples.
Should concerning cells ever be detected by Pathology, the nipple and/or areola can always be removed later in the office under local anesthesia. A new nipple and areola could then be reconstructed in the future at a second stage procedure by our traditional methods (local flap or nipple sharing plus medical tattoo).
In this case, her Pathology results showed normal tissue under the nipples and they were kept (which is the case 99% of the time). Her own breast skin covered the DIEP flaps, which filled her breasts in a perkier and fuller shape.
Her nipples and areolas were reapplied higher on the breast like the position in a breast reduction or lift. Follow up images are shown at 2 years after DIEP flap surgery and three months after medical tattoo of the nipples and areolas to brighten their color and provide the very best aesthetics.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
