69 year old grandmother self palpated a left breast mass in the fall of 2014. Her mass was felt at the upper outer quadrant of her left breast and she visited with her OB/GYN who ordered a mammogram. Further biopsy returned back infiltrating ductal carcinoma. Pt desired to pursue a nipple sparing mastectomy and elected for bilateral mastectomy to reduce future screening and anxiety.

Surgery 1

Pt had nipple sparing mastectomy through an inframmary fold incision. Tissue expanders were placed above the muscle in the prepectoral space. This allowed for salvage of the pectoralis major muscle and to eliminate animation deformity. Tissues expanders were gradually filled to 400 cc and here you see the patient prior to exchange to permanent anatomic silicone implants.

Surgery 2

After achieving the proper bra size, patient then underwent exchange of her tissue expanders to permanent silicone implants. Anatomic shaped implants were used along with placement of Alloderm internal sling to reinforce the reconstruction. Aggressive fat grafting was performed to the upper poles of both reconstructed breast in order to smooth out contour irregularities and to achieve a smoother transition in the upper part of the breast. Fat grafting was also performed in the lower portions of the breast to help reduce rippling. A congenitally inverted left nipple was corrected at the same time. Below are her final reconstructive results three months out from her second surgery, 6 months out from her mastectomy.