Breast Reconstruction

Mastectomy Reconstruction

Mastectomy and Reconstruction

Breast Reconstruction

This patient presented with no form of reconstruction after having both of her breasts removed due to cancer. Dr. Jalil performed a delayed bilateral breast reconstruction using spare tissue from her abdomen to create a new breast. The second stage of this procedure included reduction of the skin paddle that was present from her abdomen. At the same time, a nipple reconstruction was performed along with reduction of the breast envelope.

This patient came to us for prophylactic breast cancer reconstruction, as she was gene positive for BRCA. She elected to have her surgery done with Dr. Jalil in two stages.

The first stage was the transfer of breast tissue from the abdomen to the breast. This is termed autologous reconstruction (a.k.a. DIEP flap). The second stage included reduction of the skin paddles from the flap and a breast lift.

These results could easily be confused with a cosmetic tummy tuck—a testament to our level of surgical skill and care.

This is an example of what you can accomplish in breast reconstruction surgery when the cards are stacked against you. In this case, we see a patient who is came to us many years after their initial mastectomy (removal of breast(s) due to breast cancer). After their initial surgery, they also had to undergo treatment to reduce recurrence with radiation and chemotherapy. Radiation can be particularly frustrating for surgeons because it can result in severe damage and contraction of the skin.

In this form of reconstruction, we opted to remove all the disease contracted skin and replaced it using tissue from her abdomen. This allowed her to benefit from a slight improvement to the appearance of her abdomen as well. We also performed a breast lift on the opposite side breast. As you can see, she is now able to wear bras comfortably and her overall form has been restored.

Sometimes in breast reconstruction, it’s possible to leave a person in similar or slightly better form as to when they were first diagnosed. In this scenario, the patient presented with breast cancer and incidentally also had a breast augmentation that was done 15 years ago by another surgeon. After having a discussion about our options, she elected to go ahead with an implant-based prepectoral reconstruction.

Since her original implants were placed in the under the muscle position, we had to remove the old brass capsule and implant, reconstruct the pectoralis muscle, and then allow the general surgeon to perform a mastectomy in the nipple sparing fashion.

Although this patient certainly could’ve benefitted from a lift, she was keen on keeping her nipple if possible. We were able to perform the entire surgery from a remote IMF incision (in the breast crease), therefore minimizing the visibility of scars. She is excited about her current results and has resumed all normal activities.

This patient previously had a lumpectomy with radiation done on the right side. Unfortunately, she had some aesthetic complications as a result. The issues were related to post-radiation scarring along with a situation in which the scarring was pulling the nipple off to the side. After having a detailed discussion with this patient about her wishes and desires, we proceeded with a breast lift/reduction with lipocontouring on the left side to help with symmetry.

Next, we reconstructed the defect on the right side. This involves excising all the old scar in radiated area – once this is done a substantial defect is created. The only way to then fix this is to move or rotate nearby tissue into the defect, thus preventing irregularities or defects. This technique is often described as an Oncoplastic Reconstruction. As you can see from the postoperative photo, there is significant improvement.

Its important to keep in mind that the right side, which is radiated, will always be a little bit higher and asymmetrical. The effects of radiation are for life. However, the surgical workarounds that a surgeon can do to help improve symmetry can be seen in these photos.

This is an example of what you can accomplish in breast reconstruction when the cards are stacked against you. In this scenario, we see a patient who has presented many years after their initial mastectomy (removal of breast) due to breast cancer. After their initial surgery, they also had to undergo treatment to reduce recurrence with radiation and chemotherapy. Radiation can be particularly frustrating for surgeons because it can result in severe damage and contraction of the skin.

In this form of reconstruction, we opted to remove all the disease contracted skin and replace it with tissue from her abdomen, along with a breast lift on the opposite sided breast. As you can see, she is now able to wear bras comfortably and her overall form has been restored. Along with this, she also benefited from a slight improvement in the appearance of her tummy.

This patient underwent a nipple-sparing bilateral mastectomy with implant based reconstruction performed by Dr. Jalil. She opted for 450cc moderate plus profile implants placed above the muscle with Alloderm. The incision was hidden beneath the breast fold. Because this patient’s skin is so thin, some rippling of the implant is visible. Typically this can be corrected cosmetically at a later date with fat transfer.

This patient came to Dr. Jalil with existing breast expanders that were painful and contracted. Additionally, she was having issues with animation and deformity from the implants being under her muscle. Dr. Jalil performed a conversion from implant to autologous (self tissue) breast reconstruction.

Stage 1:
– Complete resection of breast capsule with removal of implants on both sides
– Reconstruction of pectoral muscle on both sides
– Bilateral breast reconstruction with DIEP flaps from her abdomen (used her abdominal tissue to create a new breast)
Stage 2
– Nipple creation
– Reduction of skin paddle and breast envelope
Stage 3
– Tattoo of nipple-areolar complex