Subcutaneous Mastectomy Breast Revision, Raleigh,NC*

Subcutaneous mastectomies were once a popular way to manage fibrocystic disease of the breast and were at one time ,in the 1970s through early 1990's, approved by insurance companies to minimize this condition. The procedure involve removal of the majority of the breast tissue preserving the nipple and areola. Today, this procedure is called a nipple sparing mastectomy Back in the 70s through the early 90s, many of these procedures were done by either general surgeons or plastic surgeons with less aggressive removal of breast tissue. In general, they are no longer recommended or even approved by insurance companies. Although fibrocystic disease can include some forms of breast pathology that are precancerous, prophylactic removal of the breast is generally reserved for patients with breast cancer or genetic predisposition. This 60 woman had prophylactic mastectomies performed when she was in her 20s with placement of a silicone gel breast implant. About 20 years later the implant ruptured and she had replacement by another plastic surgeon with saline breast implants. She developed a painful contracture on the right breast and was unhappy with the appearance. To improve her result, she underwent exchange to silicone gel breast implants of larger size going up from 300 cc to 400 cc and also had capsulectomy on the right side where she had severe contracture. Postoperatively she had significant improvement in appearance and comfort.