Surgery To Alter the Other Breast After Single Mastectomy With Reconstruction

After a single mastectomy with reconstruction, you may want the reconstructed breast to match the remaining breast as much as possible. If you decide to get flap reconstruction surgery (either during or after mastectomy), the plastic surgeon can sculpt the flap to match the remaining breast. But achieving breast symmetry is trickier for those who have breast implant reconstruction since implants have a preset shape.

If restoring the balance between the two breasts is important to you, there are a few surgical options you might want to consider.

You may want breast symmetry surgery after a single mastectomy with reconstruction if:

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  you had breast implant reconstruction and would like the remaining breast to match the size and shape of the reconstructed breast

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  you decided to make the reconstructed breast larger or smaller than it was before or have it lifted higher

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  you had reconstruction surgery a while ago and, over time, you find that the remaining breast needs some adjustments to match the other in appearance

Depending on the type of breast symmetry surgery you prefer, you might be able to have a procedure at the same time as a single mastectomy with reconstruction. In some cases, you and your doctor may decide it’s best to wait until you heal from the mastectomy and reconstruction and the reconstructed breast has settled into place before adjusting the remaining breast.

Any type of breast symmetry surgery should be covered by 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 also to cover reconstructive procedures.

Learn more about breast reconstruction surgery and health insurance.

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; the surgeon tunnels the implant up to its correct position.

Generally, you can resume normal activities about three to four weeks after the procedure. It can take about six to eight weeks or so for any swelling to decrease and for the breast to heal and settle into place.

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  short-term risks: soreness, bruising, or heaviness in the chest; tingling, burning, or sharp pain for a few weeks; nipple sensitivity; infection

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  longer-term risks: small risk of loss of feeling in the nipple and areola; implant may need replacement at some point

You may decide to have a breast reduction in one breast so it matches your reconstructed breast. During a breast reduction, plastic surgeons typically make 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 surgeons reattach 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. But surgeons may need to remove the nipple and then reposition it after the reduction for breasts that are very large.

Breast reduction is a more involved procedure than breast augmentation, and the recovery is a little longer. Generally, you have to wait about six to eight weeks before going back to your usual daily routine. It can take several months and even up to a year for the reduced breast to feel normal again.

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  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

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  longer-term risks: possible pain 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

It’s normal for breasts to sag over time. Your plastic surgeon may need to lift your remaining breast to match your 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. Some people require a small incision just around the areola, and others require an incision that extends from the areola to the base of the breast. The surgeon then tightens and reshapes the breast tissue, removes excess skin as needed, and makes sure the nipple and areola are in the 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 after three to four weeks.

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  short-term risks: tenderness and swelling for a few weeks; numbness in the nipple and breast for several weeks

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  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 make cosmetic improvements; sagging over time