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Updated: April 2009

Prophylactic Mastectomies, Tissue Expanders and AlloDerm®

Photo of Annie's Procedure
Photo of Annie's Procedure
Before
After

This patient has a very strong family history of breast cancer. Although she tested negative for the BRCA gene mutation, she opted to undergo bilateral prophylactic mastectomies. She is seen here before and after the mastectomies and staged breast reconstruction with tissue expanders and AlloDerm®, followed by placement of silicone gel implants.

Annie's Breast Reconstruction Story:

 

I have what you might call a strong family history of breast cancer. My mother, maternal grandmother and two maternal aunts died from the disease. I was never diagnosed with cancer, I tested negative genetically, but after my third breast biopsy in nine months, I finally got up the nerve to actually see the plastic surgeon that my breast specialist had recommended seven months earlier. After discussing a brief family and medical history, as well as the fact that my estimated chance of getting breast cancer was about 48%, he asked me a simple question that has changed my life forever: "If you were going somewhere on an airplane, and the pilot told you that there was a 48% chance that the flight was going to crash, would you get on that plane?"

The decision to have bilateral mastectomies was a simple one for me. The alternative drug therapy option was completely unappealing, and breast check-ups every three months would have destroyed what little mental stability I could maintain between doctor visits, sonograms, MRI's and mammograms.

I consider my breast specialist to be my angel, and I hold her completely responsible for saving the last two most meaningful years of my mother's life. Since she was the one that recommended my plastic surgeon to me, that was truly all I needed to proceed - especially given that she will forever be my favorite doctor and the woman that I admire most (don't tell my plastic surgeon - I tell him that he's my favorite too).

The reconstruction was scary to me in a way that was comparable to having my first baby - the thought of it was actually much worse than the actual process. Had it not been for an infection setback four weeks after surgery, the whole gig wasn't all that bad. It's not that having four tubes and bulbs of ooze sticking out of your body for a few weeks was enjoyable, but the miracles of modern medicine, painkillers, and the undying support, love and care of a wonderful husband, three beautiful children, a supportive family, and an invaluable network of friends helped the two month recovery process move along. Each day I felt a little stronger and had a little less pain than the day before.

The expanders were okay, but I didn't realize just how uncomfortable they were until they came out in October! While they were in, they didn't really bother me much, and watching my doctor and his nurse use a magnet to find the port to fill them up was actually awesome! The technology of the whole process is simply amazing.

Not having nipples was no big deal. It didn't really bother me or my husband at all. In fact, having them now is kind of the same as not having them because you can't really feel them anymore. They're pretty much just for show. I think that of all the things about the surgery, I miss the sensation of my husband's fingers there the most… not that our sex life has missed a beat. With the exception of a sleepy, narcotic-filled summer of pain relief and recovery, I am happy to say that things in the old bedroom are as steamy as ever.

Overall, my experience has really been nothing but positive. My last visit to my breast specialist was in January of 2007. During that visit, the previous years of biopsies, waiting for results, anxiety and stress were instantaneously negated when I heard her say, "I guess I'll see you next year." It had been over two years since any doctor said that to me. Until that day, it had always been a six, four, or three month follow-up. Now I wake up every morning with one less elephant in my living room. I have one less worry in my life, and I am totally packed and ready to get on that plane, because my 48% crash risk has dwindled to 1 or 2%.

 

Photos and Doctor Commentary

 

Photo of Annie's Procedure  Photo of Annie's Procedure

Pre-operative

 

Pre-operative markings for bilateral prophylactic mastectomies

 

Photo of Annie's Procedure  Photo of Annie's Procedure

Right capsular contracture after bilateral tissue expanders and AlloDerm®

Pre-operative markings for bilateral expander implant exchange

After her bilateral prophylactic mastectomies and expander AlloDerm® reconstruction, Annie developed a skin infection on her right breast.  This was successfully treated with antibiotics; however, she developed contracture of the right tissue expander reconstruction.  The above images reveal the asymmetry that followed due to the capsular contracture on the right.  At the time of her expander implant exchange, markings were made to outline the correction required for repositioning of the right breast inframammary fold position.

 

Photo of Annie's Procedure Photo of Annie's Procedure 
Photo of Annie's Procedure

After bilateral expander implant exchange

Bilateral expander implant exchange for cohesive gel implants and correction of the right fold position resulted in a symmetrical reconstruction.

 

Photo of Annie's Procedure

Pre-operative markings for bilateral nipple areola reconstruction

 

Photo of Annie's Procedure Photo of Annie's Procedure

Healed left nipple areola reconstruction

Healed right nipple areola reconstruction

After she healed from the expander implant exchange surgery, Annie returned for bilateral nipple areola reconstruction.  The nipples were reconstructed using skate flaps to create each nipple mound.  Each areola was then reconstructed with a skin graft taken from the lower abdomen.

 

Photo of Annie's Procedure Photo of Annie's Procedure

Nipple areola tattoo procedure

Immediately after nipple areola tattooing

The nipple tattooing process, completed as an office procedure, is shown here.  Immediately after the tattooing is completed, the colors are difficult to see because the pigment mixes with blood.

 

Photo of Annie's Procedure Photo of Annie's Procedure 
Photo of Annie's Procedure

Early final reconstruction

 

Photo of Annie's Procedure Photo of Annie's Procedure 
Photo of Annie's Procedure

Nearly three years after mastectomies

Annie is seen here nearly three years after her first stage surgery, proudly displaying her new Pink Ribbon Tattoo. The silicone gel implants remain soft and well-positioned. Her scars have faded and the nipple areola tattoos have faded to a more natural color tone.

 

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