Breast reconstruction is an incredible life-enhancing procedure that gives breast cancer survivors a “light at the end of the tunnel” during their often difficult oncologic treatments. Unfortunately, reconstructions of the breast are often less than perfect and may still leave patients with asymmetries and breast shapes that are difficult to hide in clothes. Revisional surgery is technically more challenging than primary surgery. Dr. Zenn has become the plastic surgeon other plastic surgeons refer to when expert reconstruction revision surgery is required.
Many patients feel grateful to be a survivor and do not feel it is right to complain about such “cosmetic” issues requiring reconstruction revision surgery. But revision of an unacceptable reconstruction is also a right.
This patient originally had bilateral mastectomies with expanders followed by implants. She was pleased initially but over time noticed changes to her left breast. It became droopy and had visible rippling of the implant.
Dr. Zenn raised the implant and reshaped the breast by removing excess skin, including the misplaced nipple. He re-supported the implant higher on the chest and wrapped it with ADM to prevent future scarring. She will have tattooing to complete the missing areola on the left and to darken the right to match.
This patient had a previous reconstruction with a DIEP flap on the right. The reconstruction never really matched her natural breast. It was too large and projected too far to the side, bumping into her arm.
Dr. Zenn reduced the volume and shape of the right breast and added volume to the left breast with fat grafting. A combination of liposuction and skin removal from the side of the right breast nicely reduced the volume and improved the shape, better matching the left. Fat grafting of the natural left breast is a great way to add volume in a soft and natural way that is not as obvious as an implant.
This patient was BRCA+ and had nipple sparing mastectomies complicated by skin and nipple loss on the right. She ultimately had her expander removed. It was later replaced and reconstructed with implants.
She came to Dr. Zenn because of asymmetry between the breasts with the left more droopy with visible implant rippling. She also had no nipple projection on the right.
Dr. Zenn performed a breast lift on the left to have the breasts match. He also fat grafted both breasts to soften them and hide the wrinkling. Notice how the fat grafting above creates a natural transition from the chest to the implant. He rebuilt the nipple by taking part of the left nipple as a graft. She will have tattooing to complete the missing areola on the right.
This patient had nipple sparing mastectomy and implant reconstruction on her right side and presented with rippling and empty areas above her implant reconstruction.
Dr. Zenn determined the implant size was fine. Moving the breast implant higher would not help and would distort the breast. The problem was thin tissue coverage. This is a great situation for fat grafting. He harvested fat, processed it, and placed it just under the skin in the areas of thinness.
Adding more coverage of the implant with fat worked well to hide rippling. Fat grafting also nicely filled the empty spaces above the breast that was caused by too much normal fat removal during the mastectomy.