Breast symmetry is a complex goal in the wake of breast cancer and mastectomy. Yet MUSC’s expert plastic surgery team strives to achieve as much symmetry as possible between your breasts and, as a result, we are changing what’s possible in breast reconstruction.
If you are having a mastectomy on one side and intend to preserve your cancer-free breast, symmetry procedures may be done on the preserved breast during a secondary stage in the reconstruction process. Possible symmetry procedures include breast reduction, breast enlargement (for example, placement of implants) or a lift (mastopexy). The surgeon also may graft fat from one area of your body and use it to add volume or correct a contour problem.
Symmetry procedures and techniques are typically covered by insurance and may be performed on the reconstructed breast to make adjustments, too.
Breast reduction can be done on your cancer-free breast to help match it to your reconstructed breast. During the reduction procedure, excess breast tissue, fat and skin are removed allowing the breast to be re-shaped into a smaller, lighter, firmer breast that sits higher on your chest. Typically, the incision is made around the areola and a vertical line extends downward and follows the natural curve of the crease under the breast. Your nipple is not detached, but simply moved to a higher position so that most women retain nipple sensation and the ability to breastfeed.
This surgery typically takes around an hour when done during the second stage of breast reconstruction. General anesthesia is used, and you will have some swelling, bruising and numbness during recovery. Expect to return back to work in about two to three weeks and resume normal activities within six weeks. Risks include bleeding, infection, loss of sensation, loss of nipple, scarring and the need for additional procedures.
Image via the American Society of Plastic Surgeons
Breast enlargement (augmentation) may be incorporated into the reconstruction process, whether you plan to add more volume at the outset or your surgeon suggests it as a tool to enhance the symmetry and appearance of your breasts.
While each situation is unique, you can talk with your plastic surgeon ahead of time to determine the most promising cosmetic options for enlargement. If you plan to have natural tissue reconstruction and you want a larger breast, you will discuss which transplant procedures will offer you the most tissue and fat. Procedures in which tissue is harvested from your abdomen, such as the DIEP flap procedure, might be the most promising. The “stacked” variation of DIEP involves taking two flaps of tissue from the abdomen and connecting them to form one breast when more fullness is desired.
Implants also offer opportunities to go up in cup size. There are two types of breast implants – silicone and saline (salt water). Saline implants do not sit like normal breasts and tend to have a rippling effect. Someone who undergoes a cosmetic breast augmentation has natural breast tissue that will cover saline implants and mask those problems. In contrast, breast cancer patients have little to no remaining breast tissue following a mastectomy. They can expect better cosmetic results with silicone gel implants, which hang more naturally and are more cohesive with less chance of rippling.
Well-known concerns about silicone implants resulted in them being taken off the market for several years, but the FDA thoroughly examined the evidence and declared them safe in 2006, allowing them to be used again. Currently, an average implant lasts for 13.5 years, and even though it will eventually rupture, it’s not dangerous. Because today’s silicone implants are made of a cohesive gel, the inner material does not “leak” and the capsule of scar tissue around the implant keeps it secure. Most people don’t notice that their silicone implant has ruptured. This usually has to be determined by an MRI. But when a saline implant ruptures, the saline leaks out and the implant goes noticeably flat.
Breast augmentation surgery lasts about 30 minutes per breast and can be done on an outpatient basis with general anesthesia. There will be temporary swelling, numbness and bruising during recovery. You may be able to return to work as early as five to seven days after surgery and resume normal activities in six weeks.
Risks include bleeding, scarring, infection, loss of sensation in breasts and nipples, hardening of the implant (capsular contraction) and the need for additional procedures.
As breasts get older and go through pregnancy or weight loss, they may be prone to sagging (ptosis). Because your reconstructed breast will be “new,” you may need a breast lift (mastopexy) on your preserved breast for the sake of consistency and balance.
Mastopexy rejuvenates breasts by elevating and reshaping them. An incision is made around the areola and extends vertically beneath this toward the crease under the breast. The nipple is not removed – it will be moved to a new, higher position – but the excess skin above and below the nipple is removed, and the breast is reshaped. If you are happy with the size of your breasts, but they are sagging, then a breast lift may be an appropriate surgery for you.
Breast lift surgery can be done in one hour on an outpatient basis with general anesthesia. You may experience temporary swelling, numbness and bruising during recovery. Most women return back to work in one to two weeks and resume normal activities in six weeks. Risks include bleeding, scarring, infection, loss of sensation in breasts and nipples and the need for additional procedures.
Fat grafting is a technique often used in the second stage of breast reconstruction to fine-tune appearance. During this procedure, fat is harvested by liposuction from one area of your body and transferred to the breast to add volume or correct a contour problem. This helps to eliminate dimpling, indentations and inward curves and allows you to achieve improved symmetry.
This is an outpatient procedure that can be completed in under an hour with very minimal recovery time. More fat is transferred than necessary because, on average, 30-70 percent of the fat that is grafted does not take. As a result additional fat grafting may be required several months later. However, the fat that does take will stay with you for life.
Advantages of fat grafting include the fact that you are using your own tissue rather than a foreign body or substance to add volume. Plus, you enjoy the added benefit of liposuction to remove fat from an area where you don’t want it.
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