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Breast reconstruction is an extremely challenging aspect of plastic and reconstructive surgery. Not only does the cancer need to be appropriately addressed, but implants are also placed in less than optimal environments. During a mastectomy, the breast tissue is removed and the only soft tissue that remains is a skin envelope. Tissue expanders and implants are placed beneath the pectoralis muscle and often an artificial dermis derived from a human or pig is placed to support the tissue expander. The nipple areola complex can be repositioned to a higher position but must move in concert with the surrounding skin envelope. Any previous nipple areola complex asymmetry often persists when the implants are placed.

Better control of the nipple areola complex can occur with a Wise-pattern mastopexy pattern, however, this would need to be performed prior to the mastectomy. Significant elevation of the nipple areola complex is often difficult after mastectomy.

The photograph demonstrates before and after bilateral mastectomy and tissue expander/breast implant reconstruction.