It is easy to assume that the goal of breast reconstruction is to restore the breast mound. While this is true, there is much more to it than recreating volume where tissue has been removed. For a woman to achieve her desired outcome from breast reconstruction, the surgeon must also address the matter of symmetry. To do so means to recreate a breast that is soft, shapely, and in proportion with the opposite breast as well as the overall body frame.
A Work in Progress
When we discuss breast reconstruction, we observe it as a process rather than a singular surgical event. To achieve optimal shape, several adjustments may need to be made over time. Tissue expanders may be necessary to prepare an ideal pocket for breast implants. Symmetry may need to be adjusted by sculpting the reconstructed breast or the “sister breast” that was not treated with mastectomy or lumpectomy.
As much as possible, surgeons prefer to coordinate breast reconstruction with mastectomy. This provides the best chance for preserving the breast envelope as well as the nipple-areola complex. Also, when possible, surgeons utilize the patient’s own tissue to reconstruct a soft, natural breast. However, this does not guarantee symmetry. To achieve ideal proportions, incisions are planned around the preservation of shape. These are best-case scenarios that cannot always be predicted. Breast reconstruction may not always be performed right away, allowing time for distortion to occur in the skin envelope. Nipple-sparing mastectomy remains a somewhat uncommon technique, and the transverse-incision mastectomy can scar the breast disproportionately. While predictability may be, well, unpredictable, adjustments to either breast can be helpful at improving symmetry and overall appearance.
Techniques for improving symmetry include:
- Mastopexy, or breast lift surgery. This may be performed on the non-treated breast if its natural slope cannot be replicated during the reconstruction of the treated breast. Breast lift surgery can elevate the entire breast and also reposition the nipple and areola to match the treated breast.
- Breast reduction. Depending on the reconstructed size of the treated breast, a surgeon may shape the unaffected breast by reducing its size and also lifting its natural droop. This can be especially beneficial when a breast implant has been used for reconstruction because implants add “perkiness.”
- Fat grafting uses a woman’s own fat cells to reshape the breasts. Fat grafting remains a relatively new technique for breast augmentation but can be ideal in some situations. The process involves liposuction to obtain fat. The harvested fat is then processed to remove irrelevant fluid and fat cells are strategically injected into the breast to enhance shape where it is needed.
Surveys have revealed that asymmetry after breast reconstruction correlates to a lower reported quality of life than reconstruction that achieves aesthetically pleasing proportions. It is important for women to know that mismatched breasts do not have to be a consequence of breast reconstruction. Symmetry is something patients are entitled to and something they can have.