Prepectoral Reconstruction after Type 4 Skin-sparing Mastectomy. Prophylactic mastectomy for BRCA mutation


Prepectoral reconstruction with type 4 skin-sparing mastectomy is indicated in women with skin redundancy and excessive space in the postmastectomy pocket. These patients have a oversized pocketwith a generous amount of subcutaneus tissue that is displaced when breast tissue is removed.

Mangement of skin redundance is a critical aspect of breast reconstruction in these patients. The implant is first placed and the skin envelope is adressed by taylor tacking that leads removal of the excess skin. The central and medial flap are taylor tacked vertically to help assess the extent of skin reduction yhat will be needed. Subsequently, the nipple reconstruction is performed using a CV flap and finally the areola tattoo.

This 61-year-old patient has been diagnosed with a BRCA1 mutation and has requested a bilateral risk reduction mastectomy. She does not want the preservation of the NACs and a type 4 skin-sparing mastectomy has been proposed
Postoperative appearance after mastectomy and the placement of two silicone implants covered with biological mesh
Subsequently, in a new intervention, the reconstruction of both nipples was performed using a CV flap.
Finally we proceeded to tattoo both areolas. The procedures lasted a total of 9 months

Next video shows the different technical aspects of this surgical procedure.