Patient 328 Gallery

Before and after left breast reconstruction revision in a 66-year-old breast cancer survivor. She was experiencing pain of her left breast reconstruction due to recurrent infections and development of constricting and scar tissue around the implant – classified as Grade IV capsular contracture. Her left reconstructed breast was bigger and more protruding than her natural right breast, and did not match her natural aesthetic.

She felt very strongly that she did not want any surgery on her right breast, and did not want to go to sleep for surgery. She was willing to accept her current results if she had to have another general anesthetic, due to past bad experiences having surgery out of state. She was thrilled to learn that since her pocket was bigger than needed, she was a candidate for the “tip toe” implant exchange procedure – a term we have given to inserting a new smaller implant under local anesthesia, while leaving the implant capsule alone.

For the tip-toe implant exchange procedure, we inject local anesthetic and make use of an existing scar, entering the implant pocket, and “tip toeing” around so as to not wake up the body’s inflammatory response, which could potentially create new scar tissue and lead to recurrent capsular contracture. We usually send a sample of scar tissue from the inside for bacterial analysis, so that we can treat our patient with an appropriate antibiotic, should any bacteria be detected in the scar tissue.

We recommend waiting at least a year before performing implant exchange under local anesthetic to ensure that past inflammation has resolved and that capsular contracture is not ongoing. For this patient, her capsule had been stable for several years, so we felt comfortable proceeding any time.

Her left nipple was reconstructed by a right-to-left free nipple graft at the same time. Medical tattoo created a more natural colored areolar circle to complete her breast reconstruction. While we formerly offered medical tattoo to our breast cancer patients, we now refer out to local paramedical tattoo experts – who really do the absolute best job at three-dimensional areola tattoo!

She was offered liposuction to her axillary rolls, but she opted not to have this additional procedure. Follow up photos are shown 6 months after surgery, with improved symmetry and a happy, much more comfortable patient.