NYC Surgeon on “Skinny Girl Mastectomy”

New York City women pride themselves on their appearances and many are extremely fit and carry little body weight.   The metropolitan area unfortunately also has some of the highest incidences of breast cancer in large part due to the high proportion of women with  BRCA I and BRCA II  genes. As a result , a high number of thin, fit women come to me requiring reconstruction at the time of their mastectomy. These patients present unique reconstructive challenges from their lack of body fat.   After the skin sparing mastectomy, they will have little fat to help soften the underlying contour of a breast implant.   With standard reconstructive techniques, rippling of the implant will be seen in their cleavage area and they are likely to have a depression in their upper chest wall.  Both these defects are obvious when the patient chooses to wear  lower necklines --- a huge disappointment and limitation to women who pride themselves on their ability to wear all kinds tight and exposed necklines. Too many of these women are young so correcting these defects is imperative.

With this in mind,  I have arrived over the years at what I term  “ The Skinny Girl Mastectomy”.   To correct the upper pole defect and to reduce the likelihood of rippling,  I sew a thick piece of Allograft over the chest muscle from the arm pit across the upper chest wall to the sternum.   Allograft is a treated skin matrix which is thick and allows the patient's own cells to grow into the matrix and become a padding to camouflage the missing breast and fat in this area.   This allows the area of mastectomy dissection to invisibly blend with the remaining unoperated chest wall tissue.   Done at the same time as the first stage breast reconstruction, it limits the risk that the patient will be self-conscious about any operated defect.  Essentially it is a spacer and padding layer right beneath the patient’s native skin.  In patients who already have had a reconstruction and have developed this telltale defect,  the Allograft can be placed as a secondary surgery, but ideally it is done at the time of the mastectomy.

Patients may ask why Allograft and not fat grafting that is increasingly popular.   The obvious answer is that the Skinny Girl really doesn’t have extra fat to harvest!     Additionally while fat grafting can be done in those patients who do have donor fat,   it may require several attempts to get a smooth, reliable result.    In my mind, achieving a certain  immediate correction of this debilitating defect should be the priority of every plastic surgeon.


NY Plastic Surgeron Dr. Carlin Vickery NY Plastic Surgeron Dr. Carlin Vickery
Throughout her 25 years as a surgeon, Dr. Carlin Vickery has consistently broken new ground in the field of plastic surgery in New York. At a time when female surgeons were a rarity, Dr. Vickery followed an arduous path to become one of the first women to achieve success as a general surgeon and as one of the top plastic surgeons in NYC. Dr. Vickery has consistently ranked as one of NYC’s top plastic surgeons by Castle Connolly Medical, and frequently attracts patients who seek a connection with a female plastic surgeon. Always learning from her patients, Dr. Vickery brings unparalleled precision, experience, and innovation to both cosmetic and reconstructive plastic surgery.
Read more on New York Surgeon Dr. Carlin Vickery's bio page


Categories: New York Plastic Surgery Blog