Patient - Breast Reconstruction

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Before

Success in breast reconstruction means different things for different patients, and different circumstances. This 68 year lady was treated for left breast cancer up north in 2010 and had both breasts removed. After, she had chemotherapy and radiation therapy to the left chest. Later, a plastic surgeon put tissue expanders in both sides. These are balloons that are gradually inflated with salt water to expand the available skin and soft tissue to make room for an implant. Unfortunately, her right side became infected and the expander had to be removed.

One and a half years later, she moved to Florida with her husband and came to me to re-visit the issue of reconstruction. Her left expander was now hard and scarred in. I gave her all of her options, including re-trying the expanders or using her own tissues. Because her left expander could not be used, I punctured it so it would deflate and she would not be so uneven. A first, she seemed inclined to forego reconstruction altogether and just accept her situation.

A few months later she returned having decided to try one more time, using expanders. She did not want to the surgery to use her own tissues. I cautioned her that failure was a very real possibility and we proceeded.  

She is shown after new expanders were placed. She had an old collection of blood on the left that had to be cleaned out. Her skin was so thin that I had to use some sheets of banked human skin to reinforce her own tissues. This has proved to be a great addition to facilitate some very challenging reconstruction issues. She did great from that surgery. The expansion proceeded and I watched her progress with great concern, on the left because of her radiation and on the right because of her prior infection. Despite this, she did well except for severe thinning of the skin in the upper, inner area of the left side. It was so thin I could almost see the expander. 

When I took her back to remove the expanders and insert implants, I reinforced that thin area with another sheet of the banked human skin. 

After

She is now 4 months out from her final implant placement. The banked human skin saved the left side where it was so thin. Her breasts are soft and stable. She is able to wear normal bras and clothes without a prosthesis. She has decided that she does not wish to have nipple/areola reconstrucion, which was an option but would have been a challenge. My only regret is that I did not fix the pucker on her right chest from the original cancer surgery. I had thought that I might use that skin elsewhere. She did not mind this at all. The result is not beautiful but serviceable and both the patient and I are very happy. This was a case where expectations had to be relatively consertive.