A 26-year-old woman with no family history of breast cancer and personal history of resection of fibroadenoma in the right breast 4 months before going to our Service.
With this unique history, a bilateral subcutaneous mastectomy was proposed as a "preventive treatment" of a possible cancer.
The patient had not been sufficiently informed about the repercussions of this procedure.
No ultrasound or mammography studies or genetic studies of BRCA 1 or 2 were performed.
Two months after the removal of the fibroadenoma, a bilateral subcutaneous mastectomy was performed in a private hospital by an oncologist in collaboration with a plastic surgeon.
In the same intervention, a 400 cc saline breast implant was placed in a subcutaneous textured fashion.
When the stitches were removed, he presented wound healing in both breasts, performing several secondary closures without result, also suffering erythema, increased temperature in both breasts and emptying of medication
In this situation he came to our Service; two months had passed since the mastectomy.
The patient reported that she had not asked for "so large" implants, since her breast volume after the intervention was almost a larger cup than she had before.
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Antibiotic treatment was performed orally for 48 hours and on the third day, surgical lavage and removal of implants with regularization of the edge of the wounds, suture and placement of drains in closed circuit that were kept for 3 days.
Three months later, 300 cc textured breast expanders were placed with an integrated valve in a retromuscular plane.
A final expansion of 320 cc was achieved and maintained for 18 months; although replacement of expanders by prosthesis was scheduled at 6 months, the patient refused new surgeries.
At this time, she began to present stabbing pain in both breasts, so the inferior complex finally included removal of expanders and placement of silicone gel implants of 295 textured nipples, periradical nipple approach, reduction of nipples.
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In the postoperative period, antibiotic treatment was administered during surgery; at one month of surgery, manual massage was initiated and ultrasound was applied, which were maintained during the second and third month, followed by Enderm.
Since the patient had persistent stabbing pain, she was treated with Colchicine for 5 months at a dose of 1 mg/day, which was retreated with 0.5 mg/day due to intestinal intolerance.
The following 4 months, he was treated with Thalidomide at a dose of 50 mg/day.
Eighteen months after implant placement, the patient still complained of painful discomfort; however, clinically the breasts were soft and in the ultrasound study there was no evidence of contracture.
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At 3 years, the patient presented frank contracture and severe pain, but did not accept a new surgical treatment due to a change of residence in the interior of the country.
A year later, the patient returned requesting surgical treatment. At this time, we decided to remove the implants and perform breast reconstruction with bilateral pediculate TRAM flap.
Microsurgical treatment had been proposed to reduce the morbidity of the abdominal rectus wall with a greater quantity of abdominal muscle, but the patient refused it.
In the reconstruction practiced no implants were used and it was necessary to place a Marlex® mesh to cover the defect of the anterior wall of the abdomen after lifting the two pedicle flaps.
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We present images of the postoperative outcome 2.5 years after reconstruction, 8 years after initial mastectomy.
