A balanced appearance (also known as breast symmetry) is the ideal outcome of any breast reconstruction surgery. You want to look and feel evenly balanced. Plastic surgeons are constantly refining breast reconstruction techniques and timing to ensure that the results are pleasing — both physically and emotionally. Still, there's a possibility that you won't be 100% satisfied with the results of your breast reconstruction.
Your new breast or breasts may not live up to your expectations for size, position, angle, or balance. They may not be as soft or feel as natural as you thought they would. You probably won't have any sensation in a breast that's been reconstructed with an implant and little sensation in a breast that's had autologous reconstruction.
One of the best ways to make sure that you're as satisfied as possible with your reconstructed breast is to ask your medical team lots of questions about what to expect. This is important even before your first mastectomy incision, because the placement and "design" of that incision can impact your reconstructive results. Ask to see photos of breast reconstructions your surgeon has performed. You can also ask your surgeon for the names of women who have had the same type of procedure you're considering. You might find it helpful to talk to another woman about her decision process, her doctors, and her satisfaction with the results.
There are some specific factors that seem to play a role in a woman's satisfaction with her breast reconstruction results:
- Size: Right after surgery, the reconstructed breast may be somewhat larger than the other breast. This is because of swelling from surgery. As the reconstructed breast heals, the swelling will go down and the reconstructed breast should be closer in size to the other breast. If there is still a noticeable size difference, your surgeon can remove some fat from the reconstructed breast.
- Weight gain: A breast that's been reconstructed with an implant doesn't gain and lose weight if you do. If you have implant reconstruction and gain weight after the surgery, you and your surgeon may want to exchange your original implant for a larger one to help restore balance to your breasts. This is less of an issue with a breast that's been reconstructed with a flap procedure, because it gains and loses weight as the body does. However, significant weight gain (or loss) could create imbalance between a reconstructed breast versus a natural breast.
- Drooping or sagging: It's hard to match the natural droop of your original breast. A breast reconstructed with an autologous procedure may develop some sag with time and gravity, but a breast reconstructed with an implant rarely sags. Over time, your other breast may sag while the reconstructed breast remains higher and firmer. When you have a bra or bathing suit on, it may be fine, but when you're naked it might bother you. If it does, it's usually much easier for your surgeon to reduce and lift your other breast to match the reconstructed breast. For more information, see Altering the Opposite Breast.
- Changes in breast sensation: When your reconstructed breast is touched, it will feel much like your natural breast to you or whoever else is touching it. Still, you probably won't feel much sensation in your breast while it's being touched. This is because most of the nerves are cut during mastectomy and reconstruction and the area becomes numb. This can be troubling for women whose breasts were an important erogenous zone. The nerves do have the potential to regrow, but it can take a long time. If the nerves start to regrow, you may feel tingling or other sensations in your breast. If any sensation is going to come back in your breast, it's likely you'll start to feel something in a year or two. If you have no sensation in your breast, you may get feeling back in the area next to your breast. Some women find that the armpit next to the reconstructed breast becomes tremendously sensitive to touch and is a new erogenous zone.
If you're not as satisfied as you thought you would be with your reconstructed breast, talk to your surgeon and other members of your medical team. There may be steps that you and your team can take to improve the look and feel of the reconstruction.
Watch a video about how one woman made the decision to undergo DIEP flap reconstruction surgery after one of her breast implants ruptured.
Listen to the Revision Reconstruction: What You Need to Know podcast for more information.