Case of the Month · September 2026
The BRCA+ breast, rebuilt.
A 55-year-old woman with the BRCA breast-cancer gene and a very strong family history chose to remove the tissue that put her at risk — and rebuild, in the same operation. Risk-reducing subcutaneous mastectomy with free nipple graft, breast lift, and total submuscular reconstruction with 400cc smooth silicone gel implants, shown before and 4 months after. Documented and written by the operating surgeon.
The author
Written by the surgeon who operated.
Every Case of the Month is documented by the operating surgeon — the decisions, the anatomy, and the honest result. This case: Dr. Angelo Cuzalina, MD, DDS — founder of Tulsa Surgical Arts, past president of the American Academy of Cosmetic Surgery and of the American Board of Cosmetic Surgery, and director of the AACS-accredited fellowship.
Real patient · written consent on file · individual results vary · published September 2026
The result · interactive
Before, and 4 months after.
Three views of the same patient. Every image is published with written consent and attributed to the operating surgeon. Drag any line.
BeforeAfter
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Front — before and 4 months after · by Dr. Cuzalina
BeforeAfter
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Oblique — before and 4 months after · by Dr. Cuzalina
BeforeAfter
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Profile — before and 4 months after · by Dr. Cuzalina
The case
The patient, and the plan.
The patient
- 55 years old · 5′7″ · 157 lbs the day of surgery
- Maximum weight 245 lbs — breast changes from both genetics and weight loss
- BRCA+ (breast-cancer gene), with a very strong family history of breast cancer
- Ptotic, constricted, somewhat conical breasts with asymmetry
- Goal: a very natural shape, close to a C cup
The operation
- Subcutaneous mastectomy with free nipple / areolar graft
- Breast lift (mastopexy)
- Total submuscular breast augmentation — 400cc smooth silicone gel, round, low-plus profile
- Liposuction of the axilla and sides of the breast — 900cc
- All excised breast tissue weighed and sent for microscopic evaluation
Why one operation
- Risk-reducing removal of breast tissue and reconstruction performed simultaneously
- Implants placed in a total submuscular position beneath the mastectomy plane
- Free nipple grafting preserved the nipple-areolar complex on the new mound
- Result assessed at 4 months — shown above exactly as photographed
In the surgeon’s words
Dr. Cuzalina’s case notes.
This is a 55-year-old female treated by Dr. Angelo Cuzalina. She is 5′7″ tall and 157 lbs the day of surgery. However, she had a maximum weight of 245 and had physical breast changes related to both genetics as well as weight loss. The patient is also BRCA+ (breast-cancer gene) with a very strong family history of breast cancer. Therefore, the patient opted to have a subcutaneous mastectomy with free nipple graft and simultaneous placement of breast implants in a total submuscular position. Removing often 99% of mammary tissue is thought to significantly lower breast cancer risk for a certain group of patients such as this.
According to sources such as www.cancer.gov, the risks for developing breast cancer are significantly higher in people who inherit a harmful change in certain genetic situations such as BRCA1 or BRCA2. It is also noted that ‘More than 60% of women who inherit a harmful change in BRCA1 or BRCA2 will develop breast cancer during their lifetime.’ By contrast, about 13% of women in the general population will develop breast cancer during their lifetime.
This particular patient, who desired a very natural shape and close to a C cup, is shown before and 4 months after she had a breast lift (mastopexy) with subcutaneous mastectomy, free nipple / areolar graft, liposuction of her axilla and sides of the breast, plus total submuscular breast augmentation using round but low-plus-profile smooth 400cc silicone gel breast implants.
A total of 900cc of fat was removed from the sides of her breast and axilla, while the breast tissue directly excised was weighed before sending for microscopic evaluation. The patient had very challenging ptotic (sagging) breasts that were also constricted and somewhat conical in shape, in addition to her breast asymmetries. Dr. Cuzalina loves performing this type of difficult breast surgery, particularly when it can make such a major difference in a patient’s life, health, and how they see themselves.
Case notes by Dr. Angelo Cuzalina, MD, DDS — the operating surgeon, lightly edited for the web · statistics quoted from the National Cancer Institute (cancer.gov), linked above
The series
One real case. Every month.
The Case of the Month is Tulsa Surgical Arts’ teaching-practice series: each month, one of our surgeons documents a single real case in depth — the anatomy of a decision, not an advertisement. Every case is published with written patient consent, attributed to the operating surgeon, and written in their own words.