45 year old healthy mother presented with suspicious calcification in the left breast on yearly mammogram. Subsequent workup with stereotactic biopsy returned back infiltrating ductal carcinoma. Patient desired to pursue a left skin sparing mastectomy and was not deemed an acceptable candidate for nipple sparing mastectomy given the proximity of the lesion to the nipple areolar complex. Because of her natural breast shape and one sided mastectomy, she was recommended a DIEP flap reconstruction of the left breast to obtain better symmetry. Implant based reconstruction would more likely result in two different breast shapes.
Patient is seen below after successful left breast reconstruction with a DIEP flap three months out. The skin from the DIEP flap replaced the nipple and areola skin that was removed with the mastectomy. Left breast size is similar to the right breast however, right nipple is now lower than the left.
The second surgery involves revisional surgery to obtain better symmetry between the right and left breast after a successful breast mound has been created. Aggressive liposuction of the flanks was performed to improve her body contour with the fat purified and grafted (injected) to the left breast. The majority of the fat graft is placed in the upper pole of the left breast to smooth out any contour irregularities and produce a smooth transition between the DIEP flap and mastectomy skin. The left nipple was also reconstructed with a modified CV flap and a breast lift symmetry operation was also performed on the right breast in order to raise the nipple to a better position.
The finishing touches to the reconstruction include the 3D tattoo. In office tattoo is performed three months after the nipple in reconstructed so that it is well healed. Patient is seen below 6 months after tattoo has been completed with a stable left breast reconstruction of comparable size to the right breast. DIEP flap donor scar from the abdomen is well hidden just below her underwear.
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