Patient - Breast Reconstruction

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Before

This lady was seeking bilateral breast reconstruction. She had earlier undergone bilateral mastectomies for cancer of the left breast with postoperative radiation therapy to her chest. The ideal reconstruction in such cases would probably use her own tissue instead of implants but she was so thin that there was really no place from which to obtain sufficient skin and fat to build even one breast. After a thorough discussion of the risks, she opted to let me try to do this with a tissue expander and implants.

After

She is shown nearly two years after completion of her reconstruction with 300 cc Mentor MemoryShape anatomically-shaped, textured silicone gel implants* and nipple/areola reconstruction with nipple flaps and skin grafts from her thighs for the areolae. I would have liked to have gotten her a bit larger but her left breast resisted the expansion to where I felt this was as large as we would be able to go. She actually did surprisingly well and experienced no complications during her reconstruction. Her left breast has shrunk a little bit and demonstrated more wrinkling, probably a consequence of her radiation, but both breasts have remained acceptably soft. The result is less than ideal but much better than what she started with and she is content. This is an example of the importance of managing patients’, and my own, expectations in situation where the circumstances for reconstruction are far from ideal.

*These are not the implants primarily implicated in later development of lymphoma of the breast. The lifetime risk with these implants is estimated to 1:30,000.