51 year old mother presented with right breast cancer in 2014. Patient underwent a screening mammogram demonstrating suspicious calcification in the right breast. Further workup revealed DCIS. Patient elected for bilateral mastectomy and was a good candidate for nipple sparing mastectomy given her tumor size and far distance from the nipple.
A nipple sparing mastectomy was performed through an inframammary fold incision for optimal cosmetic results. Below you see the patient three months after tissue expanders had been placed and inflated to 500 cc. Patient desired to be slightly larger than her preoperative bra size. Asymmetry is quite common after the initial mastectomy and subsequent revisions are made to improve outcome.
At the second surgery after the mastectomy, the patient underwent removal of both tissue expanders with placement of permanent silicone implants. Alloderm is also routinely placed, such as in this patient, to reinforce the reconstruction and to prevent rippling. Additional fat grafting is routinely performed to smooth out contour irregularities, thicken mastectomy skin flaps and improve superior pole volume. Patient is seen 6 months after completion of second surgery with good symmetry, more projection, and a well concealed inframammary fold scar.
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