Patient 186 Gallery

Before and after bilateral breast implant reconstruction revision in a 41-year-old breast cancer survivor. A year after her mastectomies, implant reconstruction and completion of chemotherapy, she had developed capsular contracture that was limiting her arm and shoulder range of motion and causing sensations of tightness and discomfort.

We describe a mastectomy as akin to “a bomb going off” – significant inflammation occurs with removal of the breast – this is normal and expected after this major surgery. Therefore, some degree of scar tissue always forms around a breast implant when it is inserted at the same time as the mastectomy, known as “immediate implant reconstruction”.

This is why we rarely perform “direct-to-implant” reconstruction with a permanent full-sized silicone gel breast implant – we instead use a smooth round adjustable implant that is filled with saline so that it can be deflated not if, but WHEN scar tissue forms as healing occurs after a mastectomy. The space is opened up in a secondary procedure called a capsulectomy and the saline implant is exchanged for the full-sized silicone implant.

Her revision involved bilateral capsulectomy (scar tissue removal), implant exchange and liposuction of the axillary rolls (armpit fat and bra rolls). Long-term follow up photos are shown over 5 years after surgery. Once breast cancer treatment is complete, recurrence of scar tissue/capsular contracture is rare. She has maintained a soft and symmetric result with a chemotherapy port scar that is mildly hypertrophic but maturing with steroid injections.