Patient - Breast Reconstruction

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This woman had a history of multiple breast biopsies in the past, all benign. Her family history for breast cancer was extremely strong and she and several sisters tested positive for the BRAC breast cancer gene mutation, which meant her risk of breast cancer was extremely high. She wanted to have a prophylactic (preventitive) removal of both breasts and breast implants placed. She really wanted to do everything in a single procedure. She also wanted to be smaller than she was naturally. This was a tall order, but she was healthy and I felt the chance of success was good. This is one of the hardest things to do in breast reconstruction. Her bra size was a padded B cup. Despite her age, her breasts were youthful and "perky".

Breast Reconstruction - Dr. Richard Bosshardt
Breast Reconstruction - Dr. Richard Bosshardt


I performed a bilateral nipple-sparing mastectomy through an incision midway between the nipple and lowermost crease under the breast. I took care to remove all the breast tissue, which left her with very thin skin flaps. I immediately placed a pair of 190 cc Mentor MemoryGel Xtra smooth, round gel implants inside "pita pockets" of preserved human dermis, which adds some structure to her thin skin flaps and helps prevent contracture and hard breasts. She is shown just shy of two years after surgery. She is happy with the size. Her only complaint is the rippling in the upper half of her breasts. The implants I used are specially made to minimize rippling by filling them more tightly, but as can be seen, with thin flaps of skin, any implant will be seen and ripple to a degree. She is reasonably soft. We discussed some options for revision, including grafting fat into the rippled areas to fill them out, but ultimately she decided she was OK with this and did not want to risk her result with more surgery. I felt this was a good decision. 

Breast Reconstruction - Dr. Richard Bosshardt
Breast Reconstruction - Dr. Richard Bosshardt

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