A 26-year-old woman, with no family history of breast cancer and a personal history of resection of fibroadenoma in the right breast 4 months before coming to our department. With this sole history, bilateral subcutaneous mastectomy was proposed to her as "preventive treatment" for possible cancer. The patient had not been sufficiently informed about the repercussions of this procedure. She did not undergo complementary ultrasound or mammography studies, nor BRCA 1 or 2 genetic studies.
Two months after removal of the fibroadenoma, a bilateral subcutaneous mastectomy was performed in a private hospital by a medical oncologist in collaboration with a plastic surgeon. During the same operation, 400 cc round, textured, subcutaneous, saline breast implants were placed in the subcutaneous plane. When the stitches were removed, she presented wound dehiscence in both breasts, several secondary closures were performed without result, and she also suffered from erythema, increased temperature in both breasts and whitish material leaking from the wounds. In this situation she came to our department; 2 months had passed since the mastectomy.
The patient reported that she had not requested such "large" implants, as her breast volume after the operation was almost one cup larger than previously.

Oral antibiotic treatment was given for 48 hours and on the third day, surgical lavage and removal of the implants with regularisation of the wound edges, suturing and placement of closed-circuit drains that were maintained for 3 days. Three months later, round, textured, 300 cc breast expanders with integrated valve were placed in the retromuscular plane. A final expansion of 320 cc was achieved and maintained for 18 months; although replacement of the expanders with prostheses was planned after 6 months, the patient refused further surgery. During this time, she began to experience stabbing pain in both breasts, so she finally agreed to the removal of the expanders and the placement of 295 cc silicone gel implants, round and textured, through a periareolar approach; at this time, the lower mammary poles were also freed, the size of the nipple-areola complex was reduced and bilateral radial capsulotomy was performed.

Postoperatively, antibiotic and anti-inflammatory treatment was administered; one month after surgery, manual massage and ultrasound application was started and continued during the 2nd and 3rd month, followed by Endermology during the 4th month.
As the patient reported persistent stabbing pain, Colchicine treatment was added for 5 months at a dose of 1 mg/day, which was reduced to 0.5 mg/day due to intestinal intolerance. The following 4 months, she was treated with Thalidomide at a dose of 50 mg/day.
Eighteen months after implant placement, the patient continued to report painful discomfort, however, clinically the breasts were soft and the ultrasound study showed no data suggestive of prosthetic rupture or the presence of capsular contracture.

After 3 years, the patient presented frank capsular contracture and significant pain, but did not accept further surgical treatment due to a change of residence to the interior of the country. One year later, she returned requesting surgical treatment, at which time we proceeded to remove the implants and perform breast reconstruction with bilateral pedicled TRAM. Microsurgical treatment had been proposed to reduce the morbidity of the abdominal wall by preserving more of the rectus abdominis muscle, but the patient refused. No implants were used in the reconstruction and it was necessary to place a Marlex® mesh to cover the defect in the anterior abdominal wall once the two pedicled flaps had been raised.

We present images of the postoperative result 2.5 years after reconstruction, 8 years after the initial mastectomy.