WHAT'S NEW

The patient is a 28 year old woman who has dense breasts and has not had children.  Her pre op bra size is 34B.  She requires a relatively large volume to distribute her firm breast tissue, but can use saline implants with minimal rippling secondary to her good coverage.  See her case presentation and more at  http://www.breastaugmentationboise.com/ .

The patient presented with a one sided, isolated breast cancer.  She desired nipple sparing mastectomy and her general surgeon felt the procedure was oncologically sound ( safe cancer treatment ) for her.  She therefore had a nipple sparing mastectomy with immediate reconstruction using an expander and acellular dermis for improved lower pole coverage.  After several months of passive stretching of the skin and controlled lowering of the expander, she was ready for exchange to a final silicone implant.

First, note that the patient has a pre op A cup breast with relatively little droop.  Second, note that the expander starts in a high position and that the breast does not immediately look attractive.  Third, note that after patient expansion, the breast envelope has been reshaped and that the patient now looks very similar to a breast augmentation with improved size and fullness.

pre mastectomy AP

pre mastectomy oblique

pre mastectomy lateral

post mastectomy / expander AP

post mastectomy / expander oblique

post mastectomy / expander lateral

post implant exchange AP

post implant exchange oblique

post implant exchange lateral

Mommy Makeover refers to a combination operation on the breasts and abdomen to improve the changes frequently seen after pregnancy.  This month’s patient has an unusual presentation.  She, in her twenties, had a breast reduction performed by another surgeon.  She then had a pregnancy as well as weight loss.  Now in her thirties, her breasts have skin changes and volume loss.  She has a nice improvement with a breast augmentation which is not as straight forward as it might appear.  Her pre op abdomen, while thin, has skin changes as well as muscular diastasis and laxity.  Mini abdominoplasty ( not cutting around the umbilicus and limiting surgery to the lower 2/3 of the abdomen ) removes a surprising amount of excess skin ( as seen tissue specimen photo ) and flattens her profile nicely.

Pre augmentation

Post Augmentation

Pre mini abdominoplasty AP

Post mini abdominoplasty AP

Pre mini abdominoplasty lateral

Post mini abdominoplasty lateral

Mini abdominoplasty specimen

Post op initial reconstruction

Post initial reconstruction oblique

Post fat grafting oblique

The patient presented post mastectomies with thin coverage and a peak shaped chest.  We discussed using latissimus flaps for improved coverage, but she wanted to avoid a more involved operation.  We used acellular dermis with the initial expander and implant reconstruction to improve the tissue thickness inferiorly and to keep the implants from sliding off the chest and into the axillae (arm pits).

She then had visible rippling secondary to the thin coverage.  This was improved with four sessions of fat grafting.  Note the decreased rippling, improved superior and medial transition from breast mound to chest.

Pre op AP

Post op AP

The patient is a woman in her 50’s who had a large surgical weight loss.  She was dissatisfied with her breast size and shape and underwent a mastopexy.  The breast tissue (parenchyma) was reshaped and sutured higher on the chest was to give as much fullness as possible.

Pre op oblique

Post op oblique