Before and after bilateral nipple sparing mastectomies and immediate prepectoral (on top of the muscle) breast implant reconstruction in a thin 56-year-old woman who had a past kidney transplant. She was on lifelong immunosuppressive medication and wished to avoid extensive surgery.
She was diagnosed with breast cancer and elected to have bilateral mastectomies. Her goal for her breasts was to be reconstructed fuller than her naturally small breast size, which she felt was always out of proportion to her 6 foot frame. She was delighted she could do this as part of her reconstruction, which made breast reconstruction a silver lining to the breast cancer experience.
Nipple sparing mastectomies were performed via an incision hidden under her breasts, in the fold, as is standard for all of our patients. Incisions placed beside the nipple and areola tend to pull the nipple laterally (to the outside of the breast), and this is very difficult to correct afterwards.
Smooth round adjustable saline filled implants were placed in the space where the breast tissue was, on top of the muscle. We do not use any ADM (acellular dermal matrix) in our reconstructions. Postoperatively, she avoided lifting more than 5 pounds for a month and took a full month off work as well. She continued her usual post-transplant medications and did not experience any complications such as wound healing problems, infection or capsular contracture.
Her implant ports were removed at 3 months in the office under local anesthesia. Follow up photos are shown 5 months after her mastectomies. She achieved her goals of fuller breasts and minimal surgery, with a natural looking result.
This patient’s surgery was over 16 years ago, when fat grafting was not commonplace. Nowadays, fat grafting would be offered to her at the time of port removal to help fill in the hollow above her implants in her upper pole of the breast region. Any second stage procedure is covered by insurance (as is mastectomy and reconstruction, by law) but is optional – but a wonderful way to add some liposuction in other stubborn areas of the body to breast reconstruction for the very best aesthetic results!
After over 660 nipple sparing mastectomies and immediate breast implant reconstructions, we truly believe this procedure is a straightforward, reliable and safe procedure for women facing breast cancer who are looking for natural looking results and who do not wish to sacrifice pectoralis major muscle function.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
