46-year-old female who underwent bilateral total skin and nipple areola mastectomy for severe chronic breast pain. She received immediate reconstruction with tissue expanders and acellular dermal matrix (Alloderm) and subsequent silicone implants were placed. She also received a cosmetic abdominoplasty during her reconstructive breast surgery. These surgeries were performed elsewhere by another surgeon. She experienced loss of the right implant due to extrusion through an open wound, which remained open for 8 months.
She presented to Richmond Aesthetic Surgery for reconstruction 8 months after the loss of the right breast implant. She required a first operation to close the open wound of the right breast. The right breast was reconstructed with a latissimus dorsi muscle flap and tissue expander due to the lack of healthy tissue at the lower portion of the breast. The left breast was raised and the implant was replaced to improve symmetry. Fat grafting of both breasts was performed in order to improve contour and provide additional soft tissue coverage of the breasts. Of note the patient had undergone unrelated abdominal surgery between breasts surgeries resulting in a lower midline abdominal scar. She is shown 4 months after fat grafting and implant placement reconstruction. The patient is currently taking a hiatus from surgery. Additional surgeries are a planned to further refine the contour of the right and left breasts.
Update: This patient underwent a final contouring surgery of the right and left breast 6 months after her previous surgery. The right latissimus dorsi muscle flap was completely buried within the right breast to improve lower pole shape and fullness. The left nipple was lowered by skin removal from the lower pole of the left breast. Additional liposuction of the abdominal wall and flanks was performed and autologous fat transfer was performed to finalize the shape of the upper portion of each breast. The patient is very pleased with her final shape.