47 year old healthy mother of two presented with abnormal findings on yearly screening mammogram. Study demonstrated a large area of calcifications in the right breast and patient underwent biopsy revealing infiltrating ductal carcinoma (IDC) in the suspicious area. Patient desired to have bilateral mastectomy to reduce her recurrence risk maximally due to being young and having two small children. Patient was seen at Memorial Plastic Surgery and a nipple sparing mastectomy through an inframammary fold incision was coordinated with a breast surgeon. Patient desired to be of slightly smaller size.

Surgery 1

After successful placement of the tissue expander in the first stage, patient is seen below after full expansion ready for exchange. Frequently, asymmetries exist after the initial mastectomy which can be corrected in the second revisional surgery. Plans for the second surgery included removal of tissue expanders, revision of both breast pockets, lowering of the left breast pocket, placement of Alloderm as an internal sling for reinforcement and placement of High profile anatomic (Gummy bear) implants for optimal shape and volume.

Surgery 2

Patient is seen below after removal of tissue expanders and placement of permanent anatomic (Gummy Bear) implants. Although breast symmetry is improved, patient and surgeon still had concerns regarding final result.

Surgery 3

Patient underwent a second revisional surgery that included aggressive liposuction of the abdomen and flanks with fat grafting to the entire breast to optimize shape and volume. Fat grafting is utilized to smooth out contour irregularities, thicken skin flaps and also improve shape and volume. Fat grafting is a common adjunct to any breast reconstruction to improve outcomes and also reduce fat deposits in specific areas that the patient complains about.

1 year postop

Patient is seen below at one after completion of reconstruction. Reconstruction has settled in and remains stable and acceptable. Scar is well hidden in the inframammary fold.