Breast Reconstruction (Individual Result May Vary)
This is a 58YO lady from Enterprise, AL. She has been diagnosed with left-sided breast cancer and has had a mastectomy on the left side. She was interested in getting reconstruction of her left breast and making her right breast looking more symmetrical to the left.
In order to reconstruct the left breast, there are two options. One option is to use a tissue expander which is a saline implant that has a special valve attached to it so you can slowly stretch the skin over several months. At that point, we would come back in and put in a silicone implant once the tissue is stretched to the size the patient desires.
The other option is to use a transverse rectus abdominis muscle flap which takes the fat from the lower abdomen and reconstructing the breast. When you use this technique, you do not have to use an implant.
In order to make the right breast look more symmetrical and more youthful, I did a mastopexy with a small breast implant. This has uplifted the right breast as well as reshaped it. Now the breasts are much more symmetrical in size and shape.
Insurance will usually pay for a significant portion of this procedure.
You can see in the pre-op view that she has had a mastectomy with excessive skin and wrinkling. The right breast is droopy with the nipple pointing inferiorly. Post operatively the breasts are much more symmetrical and positioned more closely on the chest wall. She has elected not to undergo nipple reconstruction on the left breast. This can be performed if someone desires.
This is a patient that had prior breast implants and was found to have a tumor in the nipple areolar complex on the right breast. She opted for bilateral mastectomies with immediate reconstruction that was done with Alloderm and tissue expanders subsequently exchanged for permanent gel implants using the Natrelle textured anatomic implant. The implants were 655cc. She is shown following the implant exchange operation. She has opted not to pursue the nipple areolar reconstruction. The shape of the breast has improved with better upper pole fullness and better projection. The droopiness has improved. She has a nice, feminine figure in clothing. The nipple areolar reconstruction could be done at any time with a smaller operation or with tattooing.
This lady had a significant family history of breast cancer. She had genetic testing done that demonstrated that she was a carrier of the BRCA gene which put her at a higher risk for developing breast cancer in her lifetime. After discussing her options with her general surgeon, she opted for bilateral prophylactic mastectomies, bilateral Oophorectomies, and immediate breast reconstruction. She was an excellent candidate for the nipple sparing mastectomy which she had done. At the same setting, she had her ovaries removed and I completed the surgery with placement of dermal matrix to form an internal bra followed by placement of tissue expanders. She was a large B/small C preoperatively and wished to be a full C with some upper pole fullness post completion of the reconstruction. Using tissue expanders allowed us to do that and give her a view of what she would ultimately look like. Over the ensuing months she came to the office for fill and once we were at the volume she was happy with, we returned to the operating room and replaced the tissue expanders for long lasting implants. She is now shown in post operative photographs about 9 months out after we began this process. She has a fuller upper pole contour, larger cup size, and has maintained good breast symmetry. This operation allowed her to keep her own nipple areolar complex and minimize the extent of the scarring.
This is a young, middle aged female who found a palpable mass in the upper quadrant of her right breast. It was biopsied and found to be breast cancer. She was placed on chemotherapy, which shrunk the tumor by about 50%. She opted for having both breasts removed with immediate reconstructions. She underwent original surgery to remove both breasts through a breast reduction "wise" pattern with placement of a dermal replacement as an internal bra with the tissue expanders. Over the ensuing month, the tissue expanders were inflated to their volume. She then underwent radiation of the right breast. Post completion of radiation, she was returned to the operating room where she underwent removal of the tissue expanders and placement of the long lasting implants. Several months following that, she was returned to the operating room for nipple areola reconstruction and excision of prominent lateral chest wall folds. She has gotten a nice result from her surgery. Her breasts are fairly symmetrical. She has lost a little volume in the right breast secondary to radiation changes. She, at the present, has foregone tattooing for color in the areola. This can be done at anytime at the office.
This patient was found to have a lobular carcinoma in situ on her left breast. This showed up on a routine mammogram. She had frequent mammograms and multiple biopsies on the left side. She had a pronounced family history of breast cancer. She was given multiple options and opted for bilateral mastectomies with immediate reconstructions. Because the tumor was small and deep, it was an option to do her mastectomy as a nipple sparing mastectomy, which was done through periareolar incisions with lateral extensions. Her mastectomy was done by Dr. Scott Robbins. At the completion of the mastectomy, Strattice dermal matrix was placed to serve as an internal bra with placement of tissue expanders which were expanded over time to the appropriate volume. A second operation was carried out to replace the tissue expanders with a long lasting implant, remove breast tissue beneath the nipple areola complexes, and revise Strattice on both sides. She has gotten a very nice result. She has maintained pretty much her breast size and shape and her own nipple areola complexes. She had negative margins on all of her resections and remains cancer free to date.
She came to see me after being referred by her general surgeon for considerations for immediate breast reconstructions following a planned mastectomy. She had a tumor in the left breast. The right breast was radiographically and clinically clean. She wanted her breasts larger, which would require an implant. This and other considerations prompted an implant as opposed to a flap type reconstruction. She underwent a simple mastectomy on the right and the left side, skin sparing, with immediate first stage reconstruction with expanders and implants. The expanders were inflated to volume. After which, she began chemo and did require radiation for the breast cancer on the left side. Post completion of the radiation, she was returned to the operating room where the tissue expanders were removed and a long lasting implant replaced. Subsequently some months later, she had the nipple areolas reconstructed. She, at some point, may require some tattooing for color on the nipple areola complex and possibly some further augmentation with fat grafts on the radiated left breast. Photographs are taken several months after completion of the nipple areola complex reconstructions. The shape of the breast is very nice with sharp creases, good projection of the breasts, and a larger cup size. The breasts have remained soft and natural feeling. The left breast, because of the radiation, is a little firmer and a little smaller than the right side. All in all, she has gotten a very nice result that of which she is pleased. Her preoperative breast size was a C cup is now a D.