In your professional opinion what steps should I take next for optimal reconstruction? (photos)

I've had B/L mastectomy with radiation, total axillary dissection, and Lat flap on the right. The right also has a small implant. The left has an expander. I was hoping for advice as to what types of surgeries I should do at this point for optimal reconstruction. I'm not sure the differences of all the implants, so when you recommend implant please designate size, style, shape and name or whatever. I also don't understand abbreviated medical terms. I'm 5'6" and 150lbs.

Doctor Answers 3

Next stage of reconstruction

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Hello and congrats for getting through your initial surgery and radiation.  You would be a great candidate for revision of your reconstruction. Your breasts are currently too widely spaced and asymmetric.  I would recommend replacing your implant/expander with a similar size implants and fat grafting to to improve symmetry and give a more natural appearance.  There are lots of options for revision, it's difficult to give an exact plan with your examining you and doing measurements.  Good luck!

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast reconstruction revision after latissimus flap and radiation

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In your case it will be difficult to achieve symmetry but I would approach it as follows.  After reviewing your medical history, implant history and performing a physical exam I always obtain 3D imaging to analyze the differences in the breast reconstruction side to side.  With your physical exam I would look at options for replacing your implant volumes with your own tissue.  The most common source would be the lower abdomen in the form of a DIEP flap.  Once this procedure has been performed with a minimum of 2-6 months of healing the 3D imaging is repeated.  Each side is evaluated again for volume differences and contour changes.  These are addressed with fat grafting that is performed as an out patient through a day surgery procedure.

Revising reconstruction after radiation

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So, I'd recommend a couple things for you.  You had radiation on the right, and now have an LD with an implant underneath that also has pretty bad capsular contracture, causing rippling and distortion.  Even if you took this implant out and exchanged for a new bigger one, you would have a very high chance of the contracture problem recurring.  You've also already had nipple reconstruction.  My suggestion is to have a flap done, and placed under your right flap, instead of an implant.  This will get rid of the contracture problem and likely provide you with a better size match.  If you need an implant later for better upper pole projection/cleavage that is possible also.  If you have an expander still in on the left, then whatever volume you're at you will try to match up based on your measurements, specifically your base width.  Since I don't know what volume you're at, it's hard to say, but that's not hard to do.  

Cain R. Linville, MD
Houston Plastic Surgeon
5.0 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.