Breast Reconstruction by Tissue Expansion / Implant Cases

This patient presented for a unilateral left mastectomy and underwent reconstruction using a staged approach with tissue expanders (stage 1) followed by implant placement (stage 2). Augmentation of the right breast was done for symmetry and finally, nipple reconstruction was done (stage 3) to complete the process.

This patient presented for a bilateral mastectomy. She had a strong family history of breast cancer. A staged approach with tissue expanders followed by implants and then nipple reconstruction and fat grafting has yielded a very nice outcome. Awaiting pigmentation.

This case shows the various stages involved in tissue expander breast reconstruction after a mastectomy for breast cancer. This young woman underwent a bilateral mastectomy, tissue expander, and allograft reconstruction. Three months later expanders were replaced with silicone gel implants and shaping was done. Next, bilateral nipple and areola reconstruction followed. Finally, pigmentation was done. A very fine outcome.

This case represents the all too common occurrence of a post-mastectomy with secondary deformities after an implant reconstruction. This patient came to me after her reconstruction was done by another institution.

The residual problems were that the nipple reconstruction was small and malpositioned. The implants were flat and lacked projection.

The treatment involved two stages. First, the reshaping of space (capsuloplasty/capsulectomy), placement of high profile gel implant, later fat grafting, and a new nipple reconstruction completed the outcome. A dramatic transformation.

This young woman presented with a strong family history of breast cancer and elected to undergo a bilateral mastectomy. Our techniques for nipple preservation mastectomy allows for complete removal of breast tissue, and limits incision to only under the armpit and at the breast fold. No other technique allows for that. The result is a one-stage complete reconstruction with a soft natural feel. (Remember, standard mastectomy, and reconstruction with expanders is a three-stage process).

As we look at the top left photo, we see the genesis of breast creation during various stages of reconstruction. An outstanding cosmetic outcome.

Top Left Photo – Prior to a bilateral mastectomy
Second Photo – After tissue expansion is completed
Third Photo – After expanders replaced by permanent implants and shaping
Bottom Left Photo – After nipple reconstruction
Fifth Photo – After pigmentation
Sixth Photo – Close up of pigmented nipple (Color fades to natural hue and intensity within weeks)

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 the mastectomies, followed by shaping and placement of the implants three months later, and nipple reconstruction was performed three months after that. Notice the natural outcome of the nipple reconstruction.

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 a 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.

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, while 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 hallow seen below the collar bone and above the implants with mastectomies. A fine cosmetic result!

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 the chest wall and the implants help improve the final aesthetic outcome. The second set of photos focus on before a mastectomy and after completed reconstruction. An excellent cosmetic outcome.