56 year old caucasian female presented with newly diagnosed right breast cancer. Patient noticed an indention in the lower portion of her right breast along with an associated mass behind her nipple. After workup was complete, a diagnosis of infiltrating ductal carcinoma was found. She was seen at Memorial Plastic surgery where recommendations were made for reconstruction. Patient was not a nipple sparing candidate since the cancer was too close to the nipple and surrounding skin and additional skin was to be resected around the nipple areolar complex in order to ensure adequate resection of cancer.
A skin sparing mastectomy was performed on the right breast removing not only the nipple areolar complex but also surrounding skin below. The defect was reconstructed in a single stage with a latissimus flap (back muscle) with an immediate implant. She is seen below 1 week out from surgery with a reconstructed breast mound of comparable size to the left breast. Drains are still in place and there is expected mild bruising.
3 months after her initial mastectomy, patient underwent her first revisional surgery to include aggressive fat grafting to smooth out any contour irregularities. Successful fat grafting will enhance breast shape and optimize outcome by providing better symmetry. She is seen 3 months out after revisional surgery of the right breast.
After optimizing breast shape and volume, the reconstruction is completed with nipple reconstruction and tattoo. The nipple was reconstructed with local tissue on the breast mound (modified CV flap). Patient is seen below three months out with a well healed symmetrical nipple.
Finishing touches to the breast reconstruction involves 3D tattoo. Completed and stable reconstruction is seen below 6 month out from tattoo. Tattoo of areola will frequently fade and require touch-ups. Patient declined any further intervention and was overall happy with reconstruction.
The latissimus flap involves a scar from the back in order to harvest both skin and muscle. The progression of the scar is seen below at 3 months, 6 months and 1 year from initial mastectomy surgery.
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