Christina

These are preoperative images prior to bilateral breast reduction with lift, planned in preparation for a nipple-sparing mastectomy (NSM) with DIEP flap reconstruction. The reduction and lift are critical for optimizing the outcomes of the subsequent procedures. By reshaping the breasts and elevating the nipple-areola complex (NAC), the patient reduces the weight and tension on the tissues, which enhance blood flow to the NAC. This step also helps us create a more natural breast contour during the NSM and reconstruction phases, improving aesthetic results and sensation preservation.

Breast reduction and life also address the patient’s initially large breasts, which can lead to long-term discomfort, including back, neck, and shoulder pain. Furthermore, resizing and repositioning her breasts facilitates better surgical planning and ensures the reconstructed breasts will be symmetrical and proportional to her body frame. This stage is crucial for reducing postoperative complications, particularly with larger breasts that might otherwise compromise the vascular supply to the NAC.

This photo depicts the patient 9 months following a bilateral breast reduction using a Wise-pattern skin incision. The reduction successfully reshaped and elevated the breasts, creating a more proportionate and balanced appearance. The scars demonstrate an anchor-shaped Wise pattern, which is an optimal approach for patients with significant excess skin.

In preparation for the nipple-sparing mastectomy, a nipple delay flap procedure is planned under local anesthesia in the office. This would be stage 2 and involves undermining the NAC to promote additional blood flow through the newly established vascular pathways, bypassing the reduction scars. This critical step enhances the survival of the NAC during the mastectomy and reconstruction stages by conditioning the tissue to rely on its underlying vascular network. The preparation sets the stage for a successful NSM with minimized risk of necrosis.

These images depict the patient one week post-operatively after bilateral NSM’s and DIEP flap breast reconstruction. After this 3rd stage, she is healing well but remains slightly hunched over due to abdominal tightness. This posture is common and expected during recovery. The umbilicus was removed during the procedure to address an existing hernia. This strategic decision reduces the risk of healing complications at the belly button and lower abdominal incision. The absence of the umbilicus also allows for a very low and concealed abdominal scar, enhancing the aesthetic outcome.

The skin paddles used for flap monitoring on each side are visible under the breast skin folds and will be excised as a stage 4 procedure under local anesthesia in the office as the viability of the flaps has been confirmed.

The surgical sites, including the abdominal donor area and reconstructed breasts, show typical early healing signs with mild swelling and faint redness along the incision lines. The abdominal scar is low and well-positioned, designed to be concealed under clothing. Overall, the patient’s recovery appears on track, with no visible signs of complications at this stage.

Healed after bilateral NSM and DIEP flap breast reconstruction, prior to revision surgery and umbilical reconstruction

The reconstructed breasts exhibit a natural contour, and the NAC has been preserved due to the meticulous planning and execution of the earlier stages. This image highlights the synergy between advanced reconstructive techniques and preparatory procedures like the nipple delay, ensuring an optimal blend of function and form.

The patient’s abdominal contour demonstrates smooth closure, with the scar positioned low enough to remain hidden under clothing. She is now ready for final revision surgery to address minor breast and abdominal donor site contour issues. In addition, she will undergo umbilical reconstruction as part of the last stage surgery.

These final images showcase the patient after undergoing additional revisions, including breast reshaping, abdominal contouring, and fat grafting. Liposuction was employed to refine the abdominal silhouette, and a new umbilicus was reconstructed for a more natural appearance. These revisions addressed any asymmetries and optimized the overall aesthetic results of the reconstruction.

The breasts now demonstrate improved volume and shape, thanks to fat grafting, which not only enhances contour but also adds a soft, natural feel to the reconstructed tissue. The abdomen displays a smooth, contoured profile, with the scars blending well into the natural creases of the body. The reconstructed umbilicus integrates seamlessly, completing the transformation. This comprehensive approach ensures both functional and aesthetic satisfaction for the patient.