Follow-Up Breast Reconstruction Symmetry Procedures
The main goal of breast reconstruction surgery is ultimately to restore symmetry and re-establish an overall aesthetic balance between the breasts, so symmetry procedures may be necessary after the original reconstruction. Though most women’s natural breasts are not perfectly symmetrical, ensuring that reconstructed breasts are as close as possible in shape, size and position tends to produce higher overall patient satisfaction rates.
From a surgical perspective, bilateral reconstruction (restoration of both breasts after mastectomy) is typically more conducive to achieving breast symmetry. Here, the surgeon is essentially starting with a clean slate, and does not have to match the newly reconstructed breast to an opposite, natural breast. Unilateral (one sided) breast reconstruction makes symmetry a bit trickier, as it can be difficult to match the natural droop of the unaffected breast. For unilateral breast reconstruction patients, it is not uncommon to require an adjustment procedure to the unaffected breast to achieve enhanced symmetry with the new breast. Adjustment operations may include one or a combination of the following procedures:
As stated in the The Women’s Health and Cancer Rights Act (WHCRA), additional operations performed on the contralateral (native) breast to achieve symmetry are also covered by insurance. It is important to realize that each woman’s individual reconstructive process varies, and the type and number of procedures necessary for optimal results differs depending on individual patient circumstances.
Developing a surgical plan to achieve symmetry entails a different decision-making process depending on whether the patient is having unilateral or bilateral reconstruction. Whether the patient is having flap reconstruction or implant-based reconstruction will also influence the pre-operative planning phase.
Autologous tissue transfer procedures like the DIEP/SIEA flap are ideal for recreating symmetry, especially if only one breast is to be reconstructed. Since these procedures utilize the patient’s own tissue rather than an implant, the newly created breast is soft and natural, and therefore will more closely resemble a natural breast with mild to moderate ptosis (natural drooping of the breasts).
Most patients undergo a refinement surgery after the DIEP flap procedure in order to enhance contour and fill in any defects or asymmetries that may still exist. This usually occurs around 4 months after the initial operation. The reason for this delay is to allow swelling to subside and ensure that the shape of the new breast(s) is correct before optimizing the final result.
Frequently, the unaffected breast is lifted during this procedure to achieve a more youthful, balanced appearance. If both breasts were reconstructed, then usually only minor adjustments are required to achieve symmetry. This can include fat grafting techniques, wherein fat injections are used as a contouring aid for augmenting, softening and adding volume to the breasts. Depending on the amount of symmetry refinements necessary at this stage, nipple reconstruction may also be completed at this time.