I'm 38 and had double mastectomy after being told I had the BRCA GENE. I am not happy with my results. What can I do? (Photo)

I am no longer confident, outgoing, or care for the social life. Am I being unreasonable? Does the photos below reflect other double mascetomy patients? Also will this affect the already less sensation?

Doctor Answers 4

Asymmetry after nipple sparing Mastectomy for BRCA mutation

Congratulations on a very brave choice! You may have saved your own life, even if you are currently very frustrated. First of all, I see that your skin and nipple/areola complexes are all intact. That tells me the inside reconstruction that is different on two sides can be improved. If your surgery and fat grafting has been over a year, very little else will change and you will have to have another procedure to improve the symmetry. Did you have expanders and implants? Did the plastic surgeon place an internal bra/ADM (Acellular Dermal Matrix)? Were your breasts even immediately after the surgery? Were they symmetrical at any time (including preoperatively)? Talk to your original plastic surgeon and communicate what you are unhappy with. If they say you are wrong to be unhappy or if they have no options whatsoever, consider another opinion.

Breast Asymmetry after Breast Reconstruction

It does appear that there is some asymmetry in the implant position.  This will most likely require some type of reconstruction of the fold on the underside of the breasts to correct the asymmetry and place both implants in the same position.  This often requires the use of Alloderm or another soft tissue substitute to help in re-positioning the implants.  Talk to your surgeon about a breast revision.  Also, was there an asymmetry in size of the two breasts before the mastectomies?  If so, this can often lead to an asymmetry of the reconstruction if the soft tissue envelope asymmetry is not addressed.

Breast Reconstruction Results?

When a patient undergoes a nipple sparing mastectomy and breast reconstruction, the goal is to try and make the breasts look as good as they can given the situation.  However, there are limits to what can be done given the constraints of a patient's own tissues.  In your situation, it does appear that you could do some things to achieve better symmetry between the breasts..  Supporting the lower side internally, perhaps changing implants, tailoring some breast skin, etc.  I would discuss this with your surgeon or go for a consultation with another board-certified plastic surgeon and see what they recommend.

Nipple sparing mastectomy

There are limitations at each stage with what a plastic surgeon starts with.  Fat injection may help improve some of the concerns you have. This can take more than one attempt.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

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