What do I do now - tight chest muscle 4th implant and had Doris flap to soften breast (photo)

Thank you so much for sharing your story. Breast reconstruction can be difficult and the complication rate can be high, especially after radiotherapy.It sounds and looks like your reconstructive surgeon has done all the right things. The risk of having the reconstruction fail after radiotherapy is very high (probably around 40% when you have to operate through tissue that has previously had radiotherapy). Performing the latissimus dorsi flap was the right thing to do. Unfortunately, the skin from the back which was positioned in the upper pole of the left breast and meant that the left nipple is now much lower than the right. The nipple on the right side looks high and further towards the armpit than ideal. On the positive side, the breast mounds which have been created with the implants (and flap on the left) look to be similar in shape and size. The tightness and pain you are describing on the left side are probably related to contracture of the capsule around the implants.I don't think there is any easy way to correct this. If you have enough tummy tissue, you could consider having both implants removed and replaced with free TRAM/DIEP flaps. This would involve giving you a tummy tuck but using one half of the lower abdomen to reconstruct one breast, and the other half to reconstruct the other breast. It is a major operation that requires microsurgical skills, a hospital stay or 7 - 10 days and around a month to recover BUT it may solve the problems you currently have associated with the implants.With the nipple asymmetry, this is even harder to correct. It may be that removing the nipples and have you reconstructive surgeon perform nipple reconstructions would be the best bet.I hope this helps