Case5 Immediate Definitive Prosthesis Technique

Abstract

Patient: 47 years old with positive family history.

Diagnosis:

Right breast upper quadrants invasive ductal carcinoma, previous quadrantectomy, and sentinel lymph node biopsy with compromised margins.

Unilateral Reconstruction with Contralateral Augmented Mammaplasty

• Case 62

• Patient: 47 years old with positive family history.

• Diagnosis:

  • Right breast upper quadrants invasive ductal carcinoma, previous quadrantectomy, and sentinel lymph node biopsy with compromised margins.

• Procedure:

  • Oncologic procedure:

    • Right nipple-sparing mastectomy (NSM).

    • Right NSM using the same previous quadrantectomy radial scar between upper quadrant incision.

  • Reconstructive procedure:

    • Right immediate definitive prosthesis reconstruction.

    • Anatomical implant 290 g was selected.

    • Left breast simultaneous augmentation.

    • Round shape implant 175 g through inframammary fold incision.

Fig. 5.1

Preoperative photography drawings

Ptosis grade 1, small breast size, symmetrical breasts with previous right breast quadrantectomy upper quadrant scar

Marking midline and inframammary fold

Fig. 5.2

After mastectomy and immediate reconstruction with implant

Fig. 5.3

Left side inframammary fold incision and subcutaneous oblique dissection

The dissection goes until the major pectoralis muscle insertion

Figs. 5.4 and 5.5

The major pectoralis muscle dissection from the ribs

The surgeon identifies the lateral border and begins the muscle dissection

Figs. 5.6 and 5.7

From left lateral and frontal views, the checking of the breast symmetry after test implant placement

Figs. 5.8 and 5.9

Right breast subcutaneous closure without direct contact with implant

Figs. 5.10 and 5.11

Left definitive implant placement and subcutaneous closure

This is an important step because the inframammary fold incision results in higher risk of implant extrusion compared with periareolar approach

Fig. 5.12

Bilateral skin intradermic suture

Fig. 5.13

Final results in sitting position