Unilateral delayed breast reconstruction
Fig. 2: Pre-operative (a) and post-operative (b) pictures of a patient who underwent delayed reconstruction of the left breast using a DIEAP flap, nipple reconstruction and tattooing.
Unilateral immediate breast reconstruction
(a) Pre-operative pictures of a patient with a malignant tumor in the left breast. The position of the tumor is marked by blue dye (a technique no longer used today).
(b) Post-operative pictures of the same patient 2 years after undergoing a left-sided skin-sparing mastectomy, immediate reconstruction of the left breast using a DIEAP flap, full breast adjuvant radiotherapy and in a later phase, nipple reconstruction and tattooing. The increased pigmentation of the skin is due to the radiotherapy.
(c) Post-operative pictures of the same patient 4 years postoperatively. The radiation stigmata like discoloration of the skin and fibrosis (stiffening) of the breast have subsided.
Bilateral Immediate breast reconstruction
Fig. 4: Pre-operative (a) and post-operative pictures (b, c) of an immediate reconstruction of both breasts using bilateral DIEAP flaps, after an areola-sparing mastectomy of the right breast and a skin-sparing mastectomy of the left breast (performed because the tumour was close to the nipple). (c) The right areola with a small skin island from the flap that can be subsequently used for nipple reconstruction. (d) After nipple reconstruction and tattooing of both areolas. (e, f, g) 3 years after the initial surgery, the scars have faded considerably.
Fig. 5: (a) A 43 yrs. old woman diagnosed with a BRCA-2 mutation presents for bilateral areola-sparing mastectomy and autologous reconstruction. (b) In a first operation a primary breast reconstruction is performed with a free ipsilateral SGAP flap. (c) Intermediate situation after reconstruction of the right breast with a free DIEAP flap. Note that the additional skin island of the DIEAP and SGAP cause supplementary drooping of both breasts. Also, the left breast has a typical appearance after primary shaping of an SGAP flap: important hollowing of both upper quadrants and a visible upper ridge of the flap. (d, e, f) 1 year post-operative result after the fourth procedure, involving bilateral nipple reconstruction, liposuction of the upper ridge of the SGAP flap and lipofilling of both upper quadrants.
Fig. 6: Pre-operative (a) and post-operative pictures (b) of an immediate reconstruction of both breasts using bilateral DIEAP flaps, after an areola-sparing mastectomy of both breasts. Nipple reconstruction and tattoo were done in a separate surgical procedure.
Mixed delayed and immediate bilateral breast reconstruction
Fig. 7: Pre-operative (a) and post-operative pictures (b, c, d) of an immediate reconstruction of the right breast with an SGAP flap and a delayed reconstruction of the left breast using a DIEAP flap. The DIEAP flap was chosen for the left breast as a large amount of skin was needed to recreate a normal drooping shape of the breast. The SGAP flap was chosen because the abdominal flap did not contain sufficient volume to recreate both breasts. Nipple reconstruction and tattoo were done in a separate surgical procedure.
Bilateral delayed breast reconstruction
Fig. 8: (a) status after repeated attempts at breast reconstruction with implants. The right breast was irradiated. Infection of the right prosthesis led to removal. On the left side the implant is still in place, but the shape is distorted by displacement and strong capsular contracture. (b) Situation after removal of the implants, removal of the scarred tissue caused by radiation, bilateral breast reconstruction with free DIEAP flaps, nipple reconstruction and tattooing of the areolas.