50 year old healthy mother presented with newly diagnosed left breast cancer. Patient had her yearly screening mammogram demonstrating a suspicious area in the upper outer quadrant of her left breast. Because the patient had a previous submuscular breast augmentation performed, she was not a good candidate for lumpectomy and radiation therapy. Radiation therapy with implants in place results in high capsular contracture rates in addition to a higher lifetime risk of implant infection on the radiated side. She was recommended nipple sparing mastectomy through an inframmary fold incision in order to optimize her cosmetic outcome and the patient decided on have a right prophylactic mastectomy as well.
A nipple sparing mastectomy with an inframmary fold incision was performed on the patient and immediate tissue expanders were placed. Tissue expanders were placed in the same space as her breast implants in the sub muscular (below the muscle) space. After healing for 2 weeks, tissue expanders were filled to a size that was comparable to her preoperative bra size over the course of 6 weeks. In a second surgery, tissue expanders were then removed and the replaced with permanent silicone implants reinforced with Alloderm. She is seen below 1 year out after her initial mastectomy with a stable reconstruction and a well hidden scar along the inframammary fold.
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