fig3

Figure 3. Salvage of two-stage reconstruction with flap. A 33-year-old female patient with left breast cancer at the stage of cT3N1M0 at first diagnosis. She received neoadjuvant chemotherapy and later nipple-sparing mastectomy and tissue expander insertion. The postoperative stage of her breast cancer was ypT1cN1M0. She then underwent postmastectomy radiotherapy. (A) Preoperative view; (B) Anterior view 15 months post-mastectomy, after nipple-sparing mastectomy, immediate reconstruction with a tissue expander, and completion of PMRT. The reconstructed and irradiated breast shows contracture, with the nipple positioned higher compared to the contralateral healthy breast. The patient later received implant reconstruction; (C) AP view at 17 months post-mastectomy, two months after the tissue expander was replaced with a breast implant; (D) Left lateral view at 17 months post-mastectomy, two months after implant placement. The second-stage surgery converting the tissue expander to a breast implant went uneventfully; (E) Left lateral view at 22 months post-mastectomy and 7 months post-implant reconstruction, showing wound breakdown and subsequent implant exposure caused by progressive contracture and fibrosis. After discussion with the patient, the breast implant was removed, and reconstruction was converted to a free DIEP flap transfer; (F) Free DIEP flap harvested for breast reconstruction; (G) AP view five months after DIEP flap reconstruction; (H) Left lateral view eight months post-DIEP reconstruction; (I) Right lateral view eight months post-DIEP reconstruction. PMRT: Postmastectomy radiation therapy; DIEP: deep inferior epigastric perforator; AP: anteroposterior.