Before and after bilateral nipple-sparing mastectomies and immediate breast implant reconstructions with a lift in a 41-year-old woman with breast cancer. Her cancer was not extensive and only on one side, but she chose to have a double mastectomy with immediate reconstruction based on her age and since she had young children, in order to reduce her risk of recurrence and have peace of mind.
A bilateral mastectomy was planned using a “Wise pattern” design that is used for breast reductions and lifts. Her reconstruction involved placement of permanent and postoperatively adjustable saline-filled implants on top of the muscle, in the prepectoral position.
The implants were fully inflated at the time of her surgery. No “tissue expansion” was required since there was no muscle or skin to stretch – only the empty space where the breast formerly was needed to be filled out.
Her nipples were removed and reapplied as free nipple grafts at the end of her surgery, as shown in the last image. This avoided concerns about the blood supply to the nipples since they at the lowest part of her breasts preoperatively. This is called “Grade III ptosis” (breast droop). Free nipple-areolar grafts tend to heal well but loss of pigmentation is common, causing a lighter color to the grafts after healing.
After surgery, she required chemotherapy and took a year to recover before having her last stage reconstruction. Her saline implants were removed and replaced with smooth round silicone gel breast implants, also on top of the muscle. Medical tattoo brightened her areolas and nipples to provide more definition and take attention away from her scars.
Follow up photos are shown 3 years after her mastectomy surgery, with mature scars and an aesthetic breast reconstruction result.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
