55 yo woman who underwent the new Three-Stage breast reconstruction, specifically used to reconstruct the ptotic breast. She initially had a lumpectomy with an oncoplastic breast reduction, which removes the tumor and lifts the breast and nipple-areola complex. Next, she had bilateral nipple-sparing mastectomies and simultaneous DIEP flap breast reconstruction. The third stage is simply a revision of her results (resection of skin paddle, fat grafting), and leaves her with a mommy-makeover look, where it appears as if she’s had a mastopexy and tummy tuck. She recently underwent another small revision to help with a couple of small issues and we will post her follow-up pics in a few months.
This 50 yo woman underwent a left mastectomy for cancer, but did not want the right breast altered. The tumor was too close to the nipple to spare, so her mastectomy was skin-sparing. She initially had a tissue-expander in place, but opted for a left unilateral DIEP flap. This is a great example of how a DIEP flap, even if used on one side, can help with symmetry, as it appears very natural, and behaves and looks like a normal breast. She later had nipple reconstruction followed by 3-D areola tattooing, and has a near-perfect symmetric result.
This petite 55 yo woman developed breast cancer and underwent a classic two-stage implant-based approach, using a Tissue Expander at the time of her skin-sparing mastectomy, placed in the pre-pectoral plane, and then eventually having them replaced for an implant along with fat-grafting. Tissue expanders were initially chosen because the patient wanted to have a slightly larger breast than when she started, and the tissue expander was used to help increase the size of the breast skin envelope. Her final implants are tear-drop shaped, anatomic implants. Finally, she had nipple reconstruction followed by 3-D areola tattooing. Her results show what can be achieved on a small frame and also demonstrate a very well done areola tattoo for a great overall result, shape, and look.
This is another 55 yo woman, who is an avid runner, who also was a great candidate for tissue expanders and then implants with fat grafting. She too, wanted to be slightly bigger and more symmetric than her original shape, and the expanders helped with this significantly. She had a pre-pectoral expander/implant position, which is beneficial for a number of reasons as illustrated here: the implant is not inhibited by the muscle and she does not have an animation deformity; the implant is allowed to reveal its natural shape and contour, giving her a more natural look; she had very little pain after surgery due to the fact that the reconstruction was above the muscle. She desired a natural shape, so tear-drop, anatomic implants were chosen to achieve natural aesthetic lines.
This 45 yo woman underwent bilateral mastectomies and immediate DIEP flaps, which is depicted in her pre-op photos (her pre-op pictures are missing!). This is a good example, however, of the contour problems that can be seen after DIEP flaps due to the skin flaps overlying them being thin – she just had a mastectomy. Her postop pictures though, show how filling in the tissue with fat helps to blend in and erase those contour problems creating a very nice natural result. She also recently had a very small revision in order to enhance her symmetry, and her results are even better than shown here. We will post those pictures in just a few months. Also note, her nipples were created via surgery, and then she had 3-D tattooing which looks uber-natural.
This young 40 yo woman had previously had left breast cancer treated with a lumpectomy and radiation several years ago. She then recurred, and opted for bilateral mastectomies. Due to the radiation, she underwent immediate DIEP flap reconstruction, and followed this up with implant placement and fat grafting. She was too thin to be able to achieve her size goal with fat grafting alone, hence the implant. She has opted not to do nipple reconstruction, and instead is going to get a floral tattoo, which we are anxious to see and show. I do like that her result is a good demonstration of how the DIEP flap can reconstruct the breast tissue so to speak, and if followed up with an implant, it can give a slightly enhanced look, almost like an augmentation.
This patient is also a young, 45 yo woman who was BRCA positive, but not a candidate for flap surgery. She instead had bilateral skin-sparing mastectomies, pre-pectoral tissue expander placement, followed by placement of implants along with fat-grafing. Although implant-based, she has a great breast shape and silhouette. Her nipple was created later and then she had tattooing, which gives her a great look and appearance.
60 yo woman who underwent 3-stage reconstruction. Preoperatively, she had significant breast ptosis, but was a nipple-sparing candidate otherwise. Thus, she had a lumpectomy, with bilateral oncoplastic reduction. Next she had bilateral nipple-sparing mastectomies, and simultaneous DIEP flaps for reconstruction. Lastly, she had a revision, with fat grafting. Her end result is identical to a mastopexy, but instead what is under her breast skin envelope is her previous abdominal tissue! Her scar result, mimicking a mastopexy and tummy tuck, is phenomenal, and she is extremely happy.
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