There will be an estimated 2600 new cases of male breast cancer in 2016.1 Mastectomy in men can leave a significant defect in chest wall appearance, but reconstruction options after mastectomy in men have not been well described. Fat grafting in men has been suggested for unilateral reconstruction,2 but bilateral reconstruction is a larger challenge for which fat grafting might be insufficient. Reconstruction following mastectomy in men with the use of “male” pectoralis implants has been described, but this may not always provide the best aesthetic outcome. We present the first reported case of using low-profile female shaped breast implants for male chest wall reconstruction after bilateral mastectomy.
A 78-year-old man with an invasive ductal carcinoma of the right breast who was found to be BRCA2-positive underwent bilateral mastectomies with plans for delayed reconstruction. He presented to the clinic preoperatively with bilateral chest central concavity (Fig. 1) with well-healed scars after his bilateral mastectomies. The patient had a subcutaneous chest wall pacemaker that precluded us from obtaining a plaster mold for a custom implant. We did not believe fat grafting would provide the convexity the patient desired and would not correct for his chest wall defects. The decision was to proceed with implant-based reconstruction. Intraoperatively, a pectoral implant was inserted on the left but did not provide sufficient correction of the concave chest defect, especially with the patient’s subcutaneous pacemaker providing superior pole fullness. Alternatively, an Allergan 410 style MM, 360-ml, shaped silicone implant (Allergan, Inc., Dublin, Ireland) was placed on the left, and an Allergan 410 style MM, 320-ml, shaped silicone implant was placed on the right. The use of a low-profile breast implant provided a correction of the chest wall defect without providing a feminine appearance. Postoperatively, the patient recovered well and was discharged the same day and was very satisfied with the result when seen at follow-up (Fig. 2).
Reconstruction following mastectomy in men is not typically described because of the rarity of male breast cancer and the lack of large defects following resection. Alternatively, unilateral mastectomy can lead to asymmetry, and bilateral mastectomy can lead to significant chest wall deformities. Men may often lack a desire for reconstruction, but reconstruction after mastectomy has a strong psychological impact in women.3 Certain subsets of male patients (including ours) may also experience the same psychological benefits for correction of postmastectomy chest wall defects. Reconstructive options include fat grating or flaps such as a latissimus dorsi muscle flap or transverse rectus abdominis musculocutaneous flap.2,4,5 These options may be insufficient or too invasive, and therefore implant reconstruction can be considered. Prosthetic-based reconstruction with standard male pectoral implants is possible but may not correct a significant chest wall deformity. This case demonstrates the option of using low-profile implants for male chest wall reconstruction. Rare cases such as male postmastectomy reconstruction are opportunities for plastic surgeons to use creative and innovative solutions to obtain an optimal outcome.
The authors have no financial interest to declare in relation to the content of this article.
Ravinder Bamba, M.D.
Department of General Surgery
Naveen M. Krishnan, M.D.
Richard Youn, M.D.
James M. Economides, M.D.
Troy A. Pittman, M.D.
Department of Plastic Surgery
MedStar Georgetown University Hospital
1. American Cancer Society. Cancer facts & figures 2016. Available at: http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf
. Accessed August 8, 2016.
2. Al-Kalla T, Komorowska-Timek E. Breast total male breast reconstruction with fat grafting. Plast Reconstr Surg Glob Open 2014;2:e257.
3. Rubino C, Figus A, Lorettu L, Sechi G. Post-mastectomy reconstruction: A comparative analysis on psychosocial and psychopathological outcomes. J Plast Reconstr Aesthet Surg. 2007;60:509518.
4. Igun GO. Rectus abdominis myocutaneous flap in reconstruction for advanced male breast cancer: Case report. Cent Afr J Med. 2000;46:130132.
5. Nakao A, Saito S, Naomoto Y, Matsuoka J, Tanaka N. Deltopectoral flap for reconstruction of male breast after radical mastectomy for cancer in a patient on hemodialysis. Anticancer Res. 2002;22:24772479.
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