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Updated: July 2009

BRCA Gene, Muscle-sparing Free TRAM Flaps
After Prophylactic Skin-sparing Mastectomies

Photo of Kristina's Procedure
final breast reconstruction and nipple areola tattoo

This patient was found to carry the BRCA gene mutation and chose to undergo bilateral prophylactic mastectomies. She is shown before and after bilateral prophylactic skin-sparing mastectomies and muscle-sparing free TRAM flap breast reconstruction.

Kristina's Breast Reconstruction Story:


My journey began at the age of fourteen with a six letter word, CANCER. My mother, a vibrant, beautiful, healthy 33-year-old woman was diagnosed with Stage 4 ovarian cancer. What I didn’t know then, was that this was the beginning of a life filled with worry and a fear of the unknown. My mother fought very hard, but lost her battle to cancer in 1992 at the age of 38. Since my mother’s death, I made a very important decision to be educated about my body. I saw my gynecologist every six months, had a pelvic sonogram every year, and was advised to go on a type of oral contraceptive that would eliminate my body from ovulating monthly. I married young and was very eager to start our family before I was in my thirties out of fear of what my mother went through. My husband and I have two beautiful sons born in 2000 and 2005.

During my second pregnancy, I asked my gynecologist about removing my ovaries. My gynecologist recommended going for genetic counseling. After reviewing my family history, which is filled with cancer, I took the next step of getting a blood test to screen for the BRCA1 and BRCA2 gene mutations. Much to my surprise, I tested positive for BRCA1. The results were earth shattering. I had as much as an 87% risk of developing breast cancer and a 44% risk of getting ovarian cancer.

After researching online, in November 2005, I decided to have a laparoscopic oophorectomy. I chose to remove my ovaries before removing my breasts because I felt that the physical change would have less of an emotional impact on me. Also, at two weeks, the recovery from the oophorectomy would be quicker than bilateral mastectomies and reconstruction. This was important for me because I had two little boys to take care of.

My oncologist told me that I could reduce my risk of developing breast cancer by 95% if I had bilateral prophylactic mastectomies. I then began my search for a breast surgeon and a plastic surgeon. In the meantime, I began taking Tamoxifen and was followed closely with mammograms, ultrasound, and MRI. I continued to see my oncologist every three months for blood work and physical breast exams. This was extremely draining for me. Every time I had an exam or a blood test, I feared the worst. This was no way to live, and was definitely not fair to my husband and children.

By the summer of 2006, I consulted with several breast and plastic surgeons. When I found the surgical team that was right for me, I knew that I had made the right choice. I scheduled bilateral skin-sparing mastectomies and immediate abdominal free flap reconstruction for July of 2007. The surgery took sixteen hours, and the first several weeks of recovery were truly difficult. I needed a lot of help from family and friends. Psychologically, I was doing better than I had expected, but I was sad that I couldn’t play with my two children. I was relieved when I looked at my new body. My scars are proof that I have taken control of my destiny and prevented cancer from happening. My hope is that this entire journey is the hardest thing that I ever have to endure in my life.

It has been thirteen weeks since my surgery, and I feel healthy as well as sexy. My breasts have never looked so good. Although I have yet to have nipple reconstruction, which is scheduled for January of 2008, no one would ever know that my breasts were reconstructed.

As I approach my 33rd birthday, the same age my mom was when she was diagnosed with cancer, I have a new outlook on life. I eat healthier, exercise and have regular check-ups with my doctor. Because of genetic testing, I was given the opportunity to make life-changing decisions to benefit my long-term health. It was important for me to remove my breasts and ovaries on my own terms. I take great pride in being called a ‘previvor,’ and I look forward to a bright, cancer-free future.

January 2008

After six months, my reconstructed breasts are ready to get nipples. Preparing for nipple reconstruction was very bittersweet for me. I had really grown to love my new breasts. They looked so amazing that I could not imagine that they could look better. Once again, I needed to go through the medical clearances and same day surgery admission process. The surgery seemed to be a success. After surgery, my surgeon advised me to keep the breasts covered. I did until the next morning, but I was anxious to see the final touches. When I looked, I was confused to see two different looking nipples. My right nipple was pink, round and plump and my left nipple was much smaller and a purplish color. Concerned, I called my surgeon who told me to come right in. His worst nightmare (and mine) had come true…my left nipple was not surviving. Jokingly, I asked if it was going to fall off. I was shocked when he responded, “Yes!” After about a week, the nipple had not fallen off but it was black. The tissue had died. On that day, my surgeon removed the nipple in his office. It did not hurt! My breast resumed the previous look, beautiful, but without a nipple. Now, we needed to let the breast tissue heal. I know that this is not the typical healing after nipple reconstruction and my surgeon was devastated with the outcome. Like I would always tell my surgeon… “I am One in a Million!”

April 2008 Nipple Reconstruction Take 2

My left breast needed ample time to heal in order to ensure successful formation of a new nipple. After waiting three months, my surgeon reconstructed a new nipple… and this time there were no complications. I actually think that the new nipple is better than the first. I was a little nervous but had total confidence in my surgeon as well as in my body. The recovery time was very quick and not painful.

I decided to wait until November to have my nipples tattooed. This is because I didn’t want to go through the tattoo healing process during the summer. After being tattooed, the nipple should not get wet or be exposed to chlorine or salt water. Typically, the tattooing can be done about three months after the nipple reconstruction.

November 2008

It was hard to believe that this was the last step of my reconstruction process. I have grown to love and adore my breast surgeon and everyone in his office. It felt weird that my journey was almost over! The tattooing process is not a complicated one. My surgeon applied a local anesthetic to the nipple area before he began tattooing. I did not feel any pain but I did feel some pressure. I have never had a body tattoo, so this was very new for me. Once the tattoo was complete, my areolas as well as both nipples were bloody and sore. The recovery was quick, approximately one week. The areola and nipple areas had to stay well lubricated during that time. I was told that the color after the procedure would not be the final pigment color. I was relieved because the color was a deep red/maroon pigment. As the first week went by, the area began to heal and form a crust like covering. As I lubricated the area, this layer fell off. This is completely normal! Once this happened, the true color became visible. Now, I cannot believe how amazing my breasts look.

Thanks to my skin sparing mastectomies and the free flap reconstruction, I do not have a visible scar on either of my breasts. I am so proud of how they look. If I chose not be vocal with my journey and reconstruction, I don’t think a single person could say that my breasts are “not real”. My breasts are a very real part of my body. I am so grateful for the journey that I chose to take. It has been eighteen months since my bilateral mastectomies and the weight of fear has been lifted from my body. I still see my oncologist twice a year, my breast surgeon once a year, and I am assuming the same for my plastic surgeon. A part of me will never feel 100% free of cancer because that would be completely naïve. I maintain control by keeping my body fit and fueled with nutritious foods. To protect my future, I will continue to care for myself and see my specialists as needed.


Photos and Doctor Commentary


Photo of Kristina's Procedure

Pre-operative markings for bilateral mastectomies and abdominal free flaps


bilateral nipple areola reconstruction

After bilateral skin-sparing mastectomies, muscle-sparing free TRAM flaps and nipple areola reconstruction

Kristina is seen here one year after her bilateral skin-sparing mastectomies and muscle-sparing free TRAM flap breast reconstruction. Five months after her first surgery, she returned to have bilateral nipple areola reconstruction. This was accomplished as an out-patient procedure using a modified skate flap technique. No additional skin was taken from elsewhere on her body in order to complete the nipple reconstruction. She is now ready for nipple areola tattoos to provide color.


final breast reconstruction and nipple areola tattoo

final breast reconstruction and nipple areola tattoo

final breast reconstruction and nipple areola tattoo

Final breast reconstruction and nipple areola tattoo

This is Kristina after she underwent the nipple tattooing process, which was completed as an office procedure. She is seen with her final reconstruction two years after her mastectomies.