PMC4855789_01
Preoperative and 11-month postoperative photographs of the 48-year-old patient (BMI = 22, bra cup size = 34D, Grade II ptosis) (anteroposterior, left lateral, right oblique views). Please note the prosthetic nipple on the mastectomy (right) side.
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A 48-year-old female (Fig. 1) presented with a multifocal lobular cancer of the right breast (requiring mastectomy) and a smaller localised tubular carcinoma of the left breast. Her preoperative and 11 month postoperative (post-RT) appearances are shown in Fig. 1. Although she developed Grade IV capsular contracture secondary to RT despite the Strattice  ADM support on the right (Fig. 1), there was no evidence of capsular contracture on the left therapeutic mammoplasty side (Fig. 5).
Planned surgical incisions (Wise pattern) for the right mastectomy and left therapeutic mammoplasty. Please note the nipple preservation on the left therapeutic mammoplasty side.
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Bilateral Wise pattern skin reduction markings were made prior to surgery (Fig. 2).
Schematic diagram showing a left nipple-areola preserving Wise pattern therapeutic mammoplasty with extended superomedial pedicle prior to transposition into the lumpectomy defect at 12 o' clock.
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A simultaneous left Wise pattern therapeutic mammoplasty with an extended superomedial pedicle (Fig. 3) was carried out with the extension transposed into the tumour excision defect.
Intraoperative radiograph with wire and coil deployed confirming the completeness of excision.
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The completeness of resection was confirmed by intraoperative specimen radiographs (Fig. 4).