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Updated: February 2010

Implants after Tissue Expanders and AlloDerm®

pre-operative bilateral mastectomies tissue expander alloerm
Final reconstruction after nipple areola tattoo center
Before
After

This patient is seen before and after bilateral mastectomies and staged breast reconstruction with tissue expanders and AlloDerm® followed by placement of silicone gel implants.

Carole's Breast Reconstruction Story:

 

What a difference a year makes! I’ve turned a glorious “60” and looking back since my diagnosis in November 2008, it’s been a remarkable journey. In addition to my breast issues, I’ve dealt with skin cancer, a thyroid biopsy, knee surgery and several other surgeries. I am finally in a place that reminds me of my resiliency.

Concerns over my breast first began in 2007 resulting in multiple diagnostic tests, follow-up appointments and aspiration of a cyst. It wasn’t until a 3-month follow-up appointment in 2008 that another suspicious area was seen behind the cyst. This new spot required a biopsy, and two days later I received the diagnosis of Invasive Ductal Carcinoma - Stage 1. The breast surgeon originally discussed doing a lumpectomy followed by radiation but ordered an MRI to confirm my diagnosis. Another cancer site was found which now altered the recommended approach… I would need a mastectomy. Knowing that I needed a mastectomy on one side, I decided to be pro-active by electing to undergo bilateral mastectomies. Because of time constraints, BRCA testing could not be completed before surgery, and the results of genetic testing would not have changed my decision. At this point, I felt lucky that continuous follow-up appointments had been recommended because my cancers were found at an early stage.

I was referred to a plastic surgeon by a friend and, upon his recommendation; I opted for expanders with AlloDerm. The expanders would later by replaced by implants. My surgery took place on December 24th and rather than opening up gifts on Christmas Day, my surgeons had to return with me to the O.R. to repair an area of bleeding. Quite a present for us all! Fortunately, this problem was easily resolved.

While everyone differs, my recovery was not easy and at times painful. I was fortunate to have my husband and a visiting nurse assist with the drains. Unfortunately, the pain medication did not agree with me and I had to rely on extra strength Tylenol. At the same time, I felt the emotional pressure to contain my feelings as my family took their cues from my responses. Wearing an emotional mask was draining!

In retrospect, 2009 was my year of healing, and my plastic surgeon’s office represented my “happy place”. My breasts were expanded with saline every two weeks and as my breasts grew, I experienced greater emotional stability. With each step, I felt healthier and a steady growth of healing. In May, I had the expanders exchanged for implants. The procedure went well and I felt more like myself. The formation of nipples followed in September and areola tattooing was done in December. Now I feel that I am back to being a happier, healthier ME and I laugh about what a perfectionist I’ve become in terms of the appearance of my breasts.

My hope and optimism truly was influenced by my plastic surgeon who told a crying Carole, “Don’t worry! I’ll fix you all up.” Every visit to his office was a “happy” visit. My doctor was making me whole again just like he promised. One year later, thanks to a wonderful plastic surgeon, his staff and support services, I feel great about myself.

 

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 mastectomies

Carole was marked pre-operatively for bilateral skin-sparing mastectomies.  The bilateral tissue expander and AlloDerm® breast reconstruction can then be performed through the mastectomy incisions. 

 

 Early post-operative after bilateral mastectomies and tissue expander AlloDerm® breast reconstruction

Early post-operative after bilateral mastectomies and tissue expander AlloDerm® breast reconstruction

Four months after expander implant exchange, Carole is ready for nipple areola reconstruction.

 

After bilateral expander implant exchange and nipple areola reconstruction

After bilateral expander implant exchange and nipple areola reconstruction

The nipples were reconstructed using modified skate flaps to create each nipple mound.  Only skin from the breasts was used for the nipple areola reconstruction without requiring skin from elsewhere on the body.

 

Final reconstruction after nipple areola tattoo right Final reconstruction after nipple areola tattoo left

 Final reconstruction after nipple areola tattoo center 

Final reconstruction after nipple areola tattoo

Carole is seen here one year after her first stage surgery.  The silicone gel implants remain soft and well-positioned. Her scars have faded and the nipple areola tattoos have a natural color tone.