This first patient had a right mastectomy for breast cancer and a left prophylactic (preventive) mastectomy. She had bilateral latissimus dorsi flap reconstruction (flaps of skin/soft tissue and muscle from the back).

This patient had a left mastectomy for breast cancer and TRAM (abdominal) flap reconstruction.

Our third patient had cancer recurrance after lumpectomy and radiation in her right breast. After removal, an expander was used with placement of an implant (right breast) and an augmentation mastopexy (left breast).

A note about Dr. English's approach to reconstruction as shown in these sequences:

"Most people take the shortcut of a simple tissue expander for breast reconstruction. I usually prefer using a latissimus flap with an expander as the additional tissue gives a more natural and durable long term result. It is a longer and more complex procedure but I feel gives a better result.

The more tissue covering an implant, the more natural it looks and feels. In addition, the back skin is thick and makes for a much better nipple reconstruction. The skin over just an expander is thin and the nipple reconstructions all flatten with time. I also tattoo the skin prior to elevating the flap for the nipple. It gives a more even color than doing the tattoo after making the nipple. All these things take a little more time but in my estimation give the patient a better result. Many doctors are interested more in speed and don't want to bother with a flap like the latissimus or tattooing prior to elevating the nipple flap."

The fourth patient had a previous breast augmentation, then (right) breast cancer. Had right mastectomy and then latissimus dorsi (back) flap with tissue expander followed by eventual implant placement, right and left.

Our fifth patient had right breast cancer. She had right mastectomy and left prophylactic mastectomy with latissimus dorsi (back) flaps and tissue expanders. Final stage with removal expanders, placement implants and nipple/areola reconstruction.

The image on the left shows this patient after a left-breast mastectomy and after the first stage of reconstruction with latissimus flap and tissue expander.

The image on the right shows the completed reconstruction after removal of the tissue expander, placement of implant and nipple/areola reconstruction

This sequence shows bilateral mastectomies with delayed reconstruction after chemotherapy. Reconstruction included latissimus dorsi flaps and tissue expanders, followed by expander replacement with implants and nipple-areola reconstruction.

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