22 year old female presented with her mother with a rapidly growing mass in the right breast. Patient first noticed the mass as a small gum ball and did not alert her mother until it continued to grow at a rapid rate. Upon presentation to her OB/GYN, the mass had grown to the size of a lemon within 3 months. Patient had biopsy performed with results highly suggestive of phyllodes tumor. Patient was immediately referred to a breast surgeon for excision. By the time the patient visited with her breast surgeon, the mass encompassed 40% of her breast. Excision of the mass alone would have resulted in an extremely poor cosmetic result and therefore recommendations of a mastectomy were discussed in order to ensure full resection of tumor and also to improve overall cosmetic outcome. Given the patients young age, a nipple sparing mastectomy through an inframammary fold incision was offered as to the best approach to conceal the scar. Patients first surgery included a nipple sparing mastectomy with immediate insertion of tissue expander.
After the tissue expander was inflated to the desired size by the patient, she proceeded to the second surgery. Patient was encouraged to over expand past her preoperative bra size so that a small implant could be placed in the left breast to achieve better symmetry. Patient is seen below after the tissue expander was removed from the right breast with placement of permanent silicone implant with internal Alloderm sling for reinforcement. The left breast was augmented with a small implant to achieve increased volume and a better shape match when compared to the right breast. Patient is seen 3 months below after exchange and augmentation with good symmetry and a natural result.
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