How would you approach surgery to align left nipple which is very lateral & the right breast implant irregularities? (Photos)

These photos are Nov 2015, almost 2 years post revision surgery Mar 2014, tear drop under muscle, 4 years after nipple sparing bilateral mastectomy, expanders and reconstruction where both implants rotated with no known cause 2 years after insertion. The implants following reconstruction were smooth, however nipple was still just as lateral. I had DCIS and LCIS, no lymph nodes taken or muscle damage. All margins are clear. I am 45 years old single with no children. thank you very much. Jo

Doctor Answers 2

Breast reconstruction revision

On the right I would use fat grafting.  On the left the areolar position needs to be changed but will not be done in a single procedure.

Revisional surgery after implant based reconstruction

Thank you for your question.

Your overall breast shape is very good and I think your surgeon has done an excellent job. The type of irregularities you have on the right breast are very common after implant based reconstruction and there are no 100% effective techniques to correct them in every case. If there is enough tissue between the skin and implant, fat grafting could be considered. I know that some plastic surgeons use acellular dermal matrix to recontour irregularities, but I have no experience with that.

The nipple asymmetry is also, unfortunately, difficult to correct. The abillity to move the nipple depends on the amount of soft tissue between the skin of the breast and the implant, and normally there is not much of this tissue in implant based breast reconstruction.

Obviously, your options will depend greatly on the findings of your physical examination. I suggest you contact your friendly local plastic surgeon for a consultation to discuss your options.

I hope this helps.

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