Patient 329 Gallery

Before and after bilateral breast reconstruction revision in a 39-year-old woman who had previously undergone bilateral prophylactic mastectomies and autogenous tissue (flap) reconstruction because she was a carrier of the BRCA breast cancer gene.

Her past breast reconstruction had not healed well and required months of wound care, resulting in significant asymmetry of her breasts and causing wearing bras to pull toward the left larger side. She did not want implants, and wanted to stay around the same size as her former breast volume.

Her revision involved liposuction and fat grafting to the right breast reconstruction. Since she had not undergone radiation therapy and her reconstruction had a healthy amount of flap tissue, her recipient site was able to potentially absorb a large amount of fat.

A single fat transfer session was performed while she was asleep in the operating room, harvesting fat from her abdomen, inner thighs and anterior flanks, and transferring nearly a liter of fat to her right breast reconstruction. Careful handling of the fat, strategic placement of small aliquots of fat in thin lines, and not overdoing it are essential to promoting success in fat grafting.

A small amount of fat was removed from the left breast reconstruction using liposuction. Excess skin and fat on the sides of her breasts that stood up like corners, called “dog ears” were revised at the same time, and additional liposuction helped to improve the contour of her bra rolls.

After surgery, she took two weeks off work and resumed exercise when all her bruising was gone (at one month). We don’t specifically recommend compression garments to the chest after lipofilling but advise our patients that compression to their liposuction donor sites will speed up the resolution of bruising and swelling. She chose to go braless after surgery, which is totally fine.

Follow up photos are shown 1 year after surgery, with dramatically improved symmetry. Additional fat grafting and/or scar revision of her right inframammary fold is an option to further improve her outcome, but she is satisfied with this revision and just wants to get on with her life – which is understandable!