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This patient diagnosed with breast cancer underwent bilateral nipple sparing mastectomy through an incision in the natural fold of the breast.  The breast was reconstructed in two stages, with tissue expanders placed in the pre-pectoral plane (on top of the pec muscle) at the time of the mastectomy followed by conversion to permanent implants two months later.  Fat grafting was performed at the second operation to smooth the contour of the breast.  The staged technique improves the structure of the skin envelope in some cases, especially in women with a larger breast or moderate ptosis (sagging).

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