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32-year-old female presents for revision breast reconstruction. She has a strong family history of breast cancer and underwent bilateral prophylactic skin and nipple-areola mastectomy with immediate reconstruction. Her first surgery was performed by another surgeon elsewhere. The lower horizontal breast incision was selected by her first surgeon and was therefore reused for her revision procedure. First stage reconstruction was performed with tissue expanders, and second consisted of placement of a permanent silicone implant with pocket revision for symmetry. She is now shown 3 years after her original surgery and is dissatisfied with her breast volume, shape, and symmetry.

Bilateral implant exchange with a larger silicone implant, extensive pocket revision, open capsulotomy, capsulectomy, and autologous tissue fat transfer (fat grafting) was performed. The previous incision was used. The patient’s breasts are now more symmetric, and the width and shape are more proportional to her frame. She is shown 4 months after surgery and is very pleased with her results.