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This young woman presented with a single unilateral breast cancer. She chose a unilateral left mastectomy. Reconstruction included a staged approach first with tissue expander and allograft. Subsequent second stage surgery three months later included removal of expander on left, shaping of the space and placement of silicone implant. The right breast had a lift and augmentation done at the second stage for symmetry. Finally, nipple reconstruction and fat grafting to the interface between upper mastectomy and implant completes her fine outcome. (Pending tattooing of nipple.)
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This young woman presented with a strong family history of breast cancer and elected to undergo bilateral mastectomy. Our techniques for nipple preservation mastectomy allows for complete removal of breast tissue, and limits incision to only under armpit and at breast fold. No other technique allows for that. The result is a one stage complete reconstruction with soft natural feel. (Remember, standard mastectomy, and reconstruction with expanders is a three stage process).
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As we look down from top photo, we see the genesis of breast creation during various stages of reconstruction. An outstanding cosmetic outcome.
Top Photo – Prior to bilateral mastectomy
Second Photo – After tissue expansion completed
Third Photo – After expanders replaced by permanent implants and shaping
Fourth Photo – After nipple reconstruction
Fifth Photo – After pigmentation
Sixth Photo – Close up of pigmented nipple (Color fades to natural hue and intensity within weeks)
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This case shows a patient in the top photos prior to bilateral mastectomies for breast cancer. The bottom three photos were taken after the necessary stages of breast reconstruction. These include; tissue expanders at the time of mastectomy, followed three months later by shaping and placement of implants, and followed three months later by nipple reconstruction. Notice the natural outcome of the nipple reconstruction.
The second set of 4 photographs show the staged process described above.
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This patient presented with disfigurement after bilateral mastectomy and staged implant reconstruction done elsewhere. Problems included asymmetry, lumpy thinned out, cold "breasts" with irregular, non breast shape, and malpositioned nipple site.
I transformed her by excising the implant scar capsules, replaced the implant with a different type of gel, recreated a new inframammary fold from the upper abdomen (which created a breast shape), repositioned the nipple to a proper location, and fat grafted the entire area including chest wall and breast reconstruction.
She now has soft, warm, well shaped breasts. An outstanding transformation.
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This case shows a young woman undergoing various stages of breast reconstruction through the tissue expander approach. The upper left photo shows the patient just prior to bilateral mastectomy for left breast cancer. The upper right photo shows the patient after completion of tissue expansion. The bottom right photo shows her after implant placement and nipple reconstruction. Finally, the bottom left photo shows her in close up to reveal the reconstructed nipple and areola. A fine cosmetic and reconstructive outcome.
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This patient is shown before bilateral total mastectomy and then after bilateral implant reconstruction, nipple reconstruction, and tattoo pigment introduction into the reconstructed breast.
This patient shows another type of breast reconstruction after mastectomy: reconstruction with implants. Aesthetic shaping with implants after mastectomy can be challenging and I am often called upon to treat patients who did not have success elsewhere.
Remember (when you are looking at these photos), these women had their breasts removed in total mastectomy! Hard to believe by the post op views. A truly outstanding aesthetic triumph here.
The second set of 4 vertical photos shows the patient at various stages of reconstruction:
First: before mastectomy
Second: with expanders
Third: with implants
Fourth: after nipple reconstruction
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This case shows a patient in the upper row of photos prior to bilateral mastectomies for breast cancer. (The photos were taken just after bilateral core biopsies). Her breast reconstruction was done with staged tissue expander, implant approach. The expanders were placed at the time of mastectomy. Silicone gel implants and shaping were done at three months, nipple reconstruction and fat grafting to the upper chest was done at another stage. The bottom photos show her after this stage; just before pigmentation. The nipple and areola covers much of the mastectomy scars. The reconstruction is a well shaped C-cup and the fat grafting camouflages the typical post mastectomy hollow seen below the collar bone and above the implants with mastectomies. A fine cosmetic result.
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This case shows a patient who underwent bilateral mastectomy (upper left), bilateral tissue expanders (upper right), later replaced by silicone gel implants and bilateral nipple reconstruction (lower right), and finally after pigmentation (lower left). Fat grafting to the area interfacing between chest wall and implants helps improve the final aesthetic outcome. (second set of photos focus on before mastectomy and after completed reconstruction). An excellent cosmetic outcome.
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This young woman presented with breast cancer and underwent bilateral mastectomy. She chose to be reconstructed by staged tissue expander-implant method.
Left: Before mastectomy
Center: After tissue expanders filled
Right: After bilateral implants (silicone gel), nipple reconstruction and pigmentation.
A truly outstanding result.
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Unilateral reconstruction of breast (this case patient's left) can be quite challenging in efforts to match the opposite side.
Here, the top photos show the patient before left mastectomy. The bottom photos show the same patient after her staged reconstruction was complete. Staged reconstruction with implants involves tissue expander placement at time of mastectomy, replacement with permanent implant and shaping months later, and finally nipple and areola reconstruction.
A near exact replica of her original breast.
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This young woman presented with unilateral breast cancer and elected to have bilateral mastectomy. Her reconstruction included staged tissue expander/implants. The first set of four photos show her progression through (from clockwise top left) prior to mastectomy, after tissue expanders, after implants, after nipple reconstruction. The second set of photos show her in various views. A fine outcome.
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Bilateral mastectomy for breast cancer can potentially have devastating psychological implications as far as physical appearance is concerned.
Top row shows patient before bilateral mastectomies. Bottom three views are taken after I completed bilateral tissue expansion, bilateral implant surgery, bilateral nipple reconstruction and pigmentation.
To me, every step is critical. It is the only way to achieve these outstanding outcomes time and time again.
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In this case, bilateral staged reconstruction involving initially tissue expanders, followed by implants, nipple reconstruction, and tattooing was done after bilateral mastectomy.
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Often women who have unilateral (single sided) breast cancer will choose to undergo bilateral mastectomies. What seems at first to be aggressive treatment may actually be the truest form of conservative treatment – life, body and mind preservation.
This patient had bilateral tissue expanders replaced with bilateral implants, and subsequent nipple reconstruction. With time scars will fade revealing a natural looking small B cup breast – a personal triumph for this well educated woman.
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With plans for bilateral mastectomies, this patient elected for staged approach with tissue expanders initially, which were later replaced with implants and subsequently nipple reconstruction with pigment tattooing. Another fine cosmetic outcome (A cup to full B cup)
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This patient presented with a plan for bilateral mastectomy:
Top row views: Pre-op
Bottom row views: After completion of various stages of implant reconstruction. Successful camouflage of potential mastectomy defect and a very nice aesthetic outcome.
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This case focuses on two important issues in breast reconstruction: how to gain symmetry, in single sided mastectomy and nipple reconstruction.
Top row left - Before mastectomy
Top row right - With tissue expander in place
Bottom row left - After reconstruction completed which included: a lift on the right side, implant replacing her expander on the left side and nipple reconstruction.
Bottom row right - A close up of my technique for nipple reconstruction and tattooing. Four to six pigments may be used to color the reconstructed nipple and areola.
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This case demonstrates the importance of the second stage procedure in creation of proper breast aesthetics. Too much emphasis is often placed on marketing and gimmicky notions of single stage expander implant devices or single stage implant reconstruction without the use of flaps (possible with TRAM or latissimus). Expanders do the work of stretching skin and muscle. Bottom row of photos reveal – aesthetically pleasing breasts after total mastectomy.
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This case depicts the common condition of a young woman with unilateral (single side) left breast cancer, who will be undergoing mastectomy: A very nice aesthetic outcome in a challenging case.
Top row views: Pre-op
Bottom row views: After left mastectomy, reconstruction with implant, nipple reconstruction, tattooing and opposite breast symmetry procedure (breast augmentation). (opposite breast surgery is often required to balance both sides)
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Camouflage of the mastectomy defect often requires a modest increase in breast size for a woman undergoing mastectomy for breast cancer. In this case the patient desired an increased breast size as well. She is shown after bilateral mastectomy, bilateral tissue expander reconstruction later replaced with implants, and bilateral nipple reconstruction with micropigmentation of reconstructed nipple and areola. When the scars fade she will look as if she has had cosmetic breast enhancement not potentially disfiguring mastectomy surgery.
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Complicated cases include: those where patients had previous mastectomy without reconstruction and then are found to have breast cancer in the opposite breast or just simply elect to later remove the opposite breast from fear or growing anxiety about repeated testing for further cancer development.
This patient is shown in her pre-op views several years after her right mastectomy and just prior to left mastectomy. The potential for dramatic asymmetries exist in these cases. Post-op views demonstrate, after bilateral reconstruction, successful pleasing results from implant reconstruction.
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This patient is shown before and after her final stage of breast reconstruction after mastectomy. In this case (as in many others), post mastectomy defects may be hard to camouflage (left); particularly in the upper middle portion. (Areas most noticeable in shirts, bathing suits, or dresses). In this case fat was taken from her hips and used to fill in the gap between the chest wall and implant subtly camouflaging visible rippling and the implant top. Nipple reconstruction completed (right).
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This set of photos reveal the pre-op planning for modified skin sparing approach in mastectomy surgery:
Left column: Pre-op
Center column: Pre-op marking including compensating for asymmetries of incision plan. When tumor sites (biopsies) are located in the medial part of the breast, incisions may be somewhat noticed in open clothes or bathing suits. The plan for opposite breast incisions is usually symmetrical unless it would be carried into difficult to conceal areas.
Right column: After implants, nipple reconstruction and tattooing.
A very successful outcome
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This case demonstrates the artistry involved in space shaping during staged implant reconstruction after mastectomy.
This patient presented after her implant stage (replacement of tissue expanders) performed initially at another surgeon’s facility, by other surgeons.
There is no shape, no definition of breast fold, no symmetry and fat excess adjacent to deficiencies. I removed the existing implants, scar capsule, liposuctioned fat excess laterally, added fat centrally, recreated a breast fold, fir a different implant into a new 3-D space and then did nipple reconstruction.
The results are dramatic.
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This case highlights how important shaping is in mastectomy reconstruction. This patient presented to me in the top photos after her staged reconstruction (elsewhere by others) with expanders and then a second procedure to place implants. She was dissatisfied with lack of shape and profound asymmetry.
I corrected these issues by removing all internal scar tissues (capsulectomy), reshaping the internal space (capsuloplasty), placing new implants (gel), and then performing nipple reconstruction. A remarkable transformation, just waiting for pigmentation.
So, my version is the bottom row of photos – other surgery outcome – the top row (before) images.
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This patient presented with breast cancer. She underwent bilateral mastectomy and staged reconstruction. She is shown during the various stages.
First set of photos – Before mastectomy
Second set of photos – With filled expanders
Third set of photos – After implants (silicone gel) replace the expanders, shaping, nipple reconstruction, and fat grafting to the upper region to camouflage the area above the implant and soften the transition between chest wall and implant.
A very good outcome.
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Many cases are available to be viewed in our office. Many Patients with outstanding outcomes decline to have their pictures shown on our website.
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