Before and after bilateral breast revision in a 42 year old breast cancer survivor. Her past surgeries had included bilateral nipple sparing mastectomies and painful, lengthy tissue expansion under the muscle, implant exchange, an attempt at reconstructing the folds of her breasts that were obliterated in past surgeries, and fat grafting.
She had bottoming out of her left breast implant and an impressive animation deformity, evident on pectoralis major muscle flexion as in the first before image. Bottoming out of a breast implant creates an unusually high position of the nipple in relation to the breast (like when you slip on a banana peel).
There was excess fat left over in her upper outer breast pole that was not removed during her mastectomy that contributed to her unsatisfactory appearance. She was not excited about another surgery, but she wanted better symmetry, less tightness and muscle spasms, and to finally be done with surgeries after conquering breast cancer.
Her breast reconstruction revision involved removal of her old breast implants and delicate separation of her pectoralis muscles from the undersurface of her mastectomy flaps (breast skin and subcutaneous fat). The inframammary folds were reconstructed on both sides using suture techniques. New intermediate stiffness (intermediate cohesivity) smooth round silicone gel breast implants were placed on top of the muscle, in the prepectoral position. No ADM (dermal or mesh products) were used.
Free fat grafting was performed as well, primarily for the benefit of her donor sites (inner and outer thighs). Fat was harvested from these areas using liposuction; some fat was injected into the medial aspect (cleavage area) of her breasts. Only 30% of the fat injected can be expected to survive after fat grafting. We offer lipo-filling/free fat grafting to our patients more for the benefit of the donor site than an expected benefit at the recipient site. Learn more about fat grafting to the breasts here.
Liposuction of the axillary rolls and the upper pole of her breasts completed her reconstruction revision procedure. Follow up photos are shown 3 months after surgery. She has greatly improved symmetry and she finally feels like she can move forward now, after facing breast cancer. Her thigh swelling is resolving and she has resumed full activity, including pushups, planks and bench press, which she was unable to do with implants under her muscles.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
