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Updated: February 2010

BRCA Gene, Prophylactic Nipple-sparing Mastectomies,
One-step Direct-to-implant and AlloDerm®

pre-operative bilateral mastectomies tissue expander alloerm
Final reconstruction after nipple areola tattoo left

This patient was found to carry the BRCA gene mutation and chose to undergo bilateral prophylactic nipple-sparing mastectomies. She is seen before and after bilateral one-step direct-to-implant and AlloDerm® breast reconstruction.

Sunshine's Breast Reconstruction Story:


I was just fifty when I was diagnosed with ovarian cancer. Actually, the doctors told me the “cyst” was benign but large so it should come out. All the tests done indicated that there was no cause for concern. When they looked at it during surgery they realized I had cancer.

The only cancer in my family was my dad’s mother who had breast cancer about fifty years earlier (and lived about thirty years after her radical mastectomy). I had a cousin who also had breast cancer but her mother (not related to me) had breast cancer as well. My gynecologist suggested that I get tested for the BRCA gene mutation because I had no known risk factors. I received the results just after my last round of chemotherapy – I carried the BRCA-2 mutation. I am very realistic, and with the knowledge of the gene mutation, I knew that I was facing a double mastectomy at some point in the future.

Once I was ready, I did my research regarding the plastic surgeon and the various types of reconstruction. I was given several recommendations for plastic surgeons and then researched each one. The best recommendations came from my oncologist’s office but I made certain to ask my gynecologist about the results he had actually seen from the various plastic surgeons. Once I knew which plastic surgeon I wanted, I had to research all the various procedures available to me.

By the time I met with my plastic surgeon, I had done plenty of research, both on him and the procedures available. At that point, I knew what I wanted and I needed him to guide me to the correct breast surgeon. I wanted my nipples retained and I knew that required a specialized procedure. In order to wake up looking as close to myself as possible, I wanted a breast surgeon who would do a mastectomy and retain my nipples. When I told this to my plastic surgeon, he knew just the breast surgeon for me, which made my choice easy.

As for the type of reconstruction, I already had a list of questions for him about the various choices and he explained everything about each option in detail. We decided that implants were the best choice for me.

Since I did not have breast cancer, this was elective surgery and I had to wait for the date to be scheduled. During the months leading up to my surgery, I decided I had to make sure that I was physically ready. In preparation, I went to a physical therapist and did strengthening exercises on my arms, pectoral and abdominal muscles.

There was a very positive side to having to wait for my surgery. During the time I was waiting, there were some advances made in the surgical procedures. By the time I was going to have my surgery, my plastic surgeon was performing the breast reconstruction and skipping the “expander” stage of the surgery. My breast surgeon would do the mastectomy and my plastic surgeon would be able to immediately replace my breast tissue with a silicone implant. I would wake up looking like nothing had ever happened AND I was not facing any further surgery.

I had my almost eight-hour surgery on a Wednesday in July. I was in the hospital until Saturday morning and then went home. I took eight weeks off from work but I knew that seven weeks to the day, I had to take my daughter to college and I had to be ready. Six weeks after my surgery I realized that I had gone through a day, maybe two or maybe more without needing even a Tylenol. That was when I knew that I was healed. I took my daughter to college, helped move her in, came back home and was able to return to life as if nothing had ever happened.

I looked like nothing ever happened and now I no longer had to worry about the imminent risk of breast cancer.

When I was diagnosed with ovarian cancer, I was on my computer researching, asking questions of my doctors and understanding anything and everything about my cancer. I did not wait for them to tell me everything; I was my own advocate.

When I knew that I should have the BRCA testing, I did all my research regarding the ramifications of testing positive for the mutation. As a result, I knew what the next step in my life was going to be.

I can remember when I had my original surgery for ovarian cancer. One of my brothers called me in the hospital and asked me if I knew what the “object” was. I told him that the object was to get better. His response was “NO, the object is to grow old”. Since then, I did what I needed to help achieve that goal. I removed my breasts, got implants, kept my nipples, lowered my risks, and I still look like nothing ever happened.


Photos and Doctor Commentary


pre-operative bilateral mastectomies tissue expander alloerm Pre-operative markings for bilateral mastectomies and latissimus flaps

Pre-operative markings for bilateral nipple-sparing mastectomies

Markings were made pre-operatively above each areola for bilateral nipple-sparing mastectomies. These markings allowed the nipple areola position to be raised such that the breasts could be “lifted” at the time of reconstruction.


 Final reconstruction after nipple areola tattoo left

 Final reconstruction after nipple areola tattoo right

 Final reconstruction after nipple areola tattoo center 

Post-operative bilateral nipple-sparing mastectomies direct-to-implant AlloDerm® breast reconstruction

This is the breast appearance eleven months after the single-stage operation. The use of AlloDerm® allowed the direct-to-implant approach in the setting of her nipple-sparing mastectomies such that the process of tissue expansion was avoided. For patients that can have a nipple-sparing mastectomy, this is an excellent option for breast reconstruction.


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