Before and after bilateral breast reconstruction revision in a 57-year-old BRCA gene-positive breast cancer survivor. She previously had undergone bilateral mastectomies and implant reconstruction, chemotherapy and bilateral breast radiation for bilateral prior breast cancer development.
She disliked the look and feel of her submuscular implants due to pain, rippling and a constantly cold feeling to her breasts. She wanted a more natural look and feel to her breasts. She was a candidate for autogenous tissue reconstruction using her own body’s tissues and chose to use her lower abdominal skin and fat for reconstruction.
Her revision involved removal of the old implants, replacement of the pectoralis major muscles to the chest wall, and microsurgical transplantation of skin and fat from her lower abdomen to her chest as bilateral DIEP flaps. Tiny blood vessels were dissected under magnification to supply the flap – typically one 2 mm artery and two accompanying veins, 2-3 mm in diameter.
This type of reconstruction is called a “free flap” because the tissue blood supply is divided from its donor site and moved free in the air, rather than staying attached to a stalk of tissue, to its new site elsewhere on the body. One artery and two veins were reconnected via suturing under the operating microscope at the chest to restore blood flow and create a new breast.
Her abdominal donor site was closed just like an abdominoplasty procedure. Liposuction removed excess fat from her armpits and bra rolls. Follow up photos are shown 3 years after surgery. She now has two soft, warm, living tissue breast reconstructions that have helped counteract much of her radiation damage, and has improved symmetry and an improved body image.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
