Some women need to have, or choose to have, bilateral mastectomy (removal of both breasts) — either because cancer was diagnosed in both breasts or they’re at very high risk of a future breast cancer due to genetic test results or strong family history. The plastic surgeon rebuilds both breasts “from scratch,” so matching them is not an issue.
More often, women only need to have a single mastectomy, which presents a new challenge: matching the reconstructed breast to the other breast. Your plastic surgeon is more likely to be successful at this if he or she uses a tissue flap procedure as opposed to an implant. (A flap can be “sculpted” to match the opposite breast, but an implant has a preset shape.) However, there may be situations in which you need surgery on the remaining breast to achieve a balanced appearance, or symmetry. For example:
- Sometimes with implant reconstruction, you may need an adjustment to the other breast. It’s not always easy to create an implant reconstruction that exactly matches the remaining breast.
- If you decide to make the reconstructed breast larger or smaller than it was before, or have it lifted higher, your surgeon will need to alter the opposite breast to match.
- Even if your surgeon does a good job at achieving symmetry, over time you may find that the opposite breast needs adjustment to truly match.
These procedures can happen at the same time as mastectomy, or, in some cases, you and your doctor may decide to wait to adjust the opposite breast until the mastectomy reconstruction has healed and settled into place.
Any procedures to achieve symmetry should be covered by group health insurance plans, thanks to the Women’s Health and Cancer Rights Act of 1998 (WHCRA). The WHCRA requires all group health plans that pay for mastectomy to also cover reconstructive procedures. For more information, see our section on Paying for Reconstruction Procedures.
Below is a quick overview of procedures that can be done to alter the remaining breast:
Breast augmentation using an implant
This surgery uses an implant to make the remaining breast fuller or firmer. Implant augmentation can be done through a number of different incisions: under the breast, around the areola, under the arm, or even through the belly button. When the incision is through the belly button, it’s called transumbilical breast augmentation, with the surgeon then tunneling the implant up to the breast. Your surgeon will decide whether to place the implant under or over the chest muscle depending on your anatomy.
Generally, you can resume normal activities in about 3-4 weeks. It can take about 6-8 weeks or so for any swelling to get better and the breast to appear more normal.
- short-term risks: soreness, bruising, and/or heaviness in the chest; tingling, burning, and/or sharp pain for a few weeks; nipple sensitivity; infection
- longer-term risks: small risk of loss of feeling in the nipple and areola; implant will need to be replaced at some point
To reduce breast size, your plastic surgeon typically makes a vertical triangle-shaped incision from the areola to the base of the breast, removing excess fat from the inside and skin from the outside. When the surgeon reattaches the skin from either side, the result is a smaller breast. A smaller incision just around the areola may be possible if only a small amount of tissue has to be removed. Usually, the nipple can remain attached to the skin; however, if the breast is very large, your surgeon also may need to remove the nipple and then reposition it after the reduction.
Breast reduction is a more involved procedure than breast augmentation, and the recovery is more difficult. Generally, it takes about 6-8 weeks before you’re able to resume normal activities. It can take several months and even up to a year for the breast to feel normal again.
- short-term risks: bruising, soreness, and swelling for several weeks; temporary loss of sensation in the nipples (it usually does come back); pain that is constant or comes and goes
- longer-term risks: possible pain and/or shooting sensations for several months to a year; damage to or loss of blood supply to the nipple, especially if it is removed and repositioned; loss of the ability to breastfeed
Most women’s breasts start to sag over time. Your surgeon may need to lift your natural breast to match your “perkier” reconstructed breast. A breast lift doesn’t make the breast bigger or smaller, although it can be combined with an augmentation or a reduction. The size of the incision usually depends on the amount of sagging: it may require a small incision just around the areola or one that extends from the areola to the base of the breast. Your surgeon then tightens and reshapes the breast tissue, removes excess skin as needed, and makes sure the nipple and areola are in correct position.
Bruising and swelling are common, and some or all of your nipple sensation may be lost temporarily. Usually you can resume normal activities in about 3-4 weeks.
- short-term risks: tenderness and swelling for a few weeks; numbness in the nipple and breast for several weeks
- longer-term risks: breast numbness for up to a year or so; permanent loss of nipple sensation (this is very rare); may need additional revision surgery to improve surgery; return of sagging over time
“Symmetry is nine-tenths of a quality reconstructive outcome. A reconstructed breast will reflect the artistry and technical talent of a skilled plastic surgeon, but it may not be possible to properly match it to your other breast without adjusting it as well.”
— Frank J. DellaCroce, M.D., F.A.C.S., Center For Restorative Breast Surgery, New Orleans, LA