Overview
The ultimate goal for breast reconstruction is to create a breast that is symmetrical with the remaining natural breast. While excellent cosmetic results and symmetry can be achieved with surgery to the reconstructed side alone, performing an operation on the healthy side can increase the options available for creating a symmetrical breast and can improve overall cosmetic results.
Many women think about changing their breast shape and size. Reconstruction is the process of creating a new breast and, for a woman unhappy with the current size or shape of her breasts, it is the ideal time to create the new breast in the size and shape that she wants. This may involve making a change to the opposite breast to ensure that both breasts match, but the final result is a reconstructive process that is as positive an experience as possible. After reconstruction with balancing surgery, women can end up with larger, firmer, smaller or less droopy breasts than before.
No surgery on the other breast
Many women feel that performing surgery to a healthy breast is unacceptable and would prefer a form of reconstruction that best matches the existing breast without any change. If your natural breasts are small and firm, implant reconstruction can give a good match, whereas if your breasts are large or quite droopy, one of the abdominal or buttock flap techniques will probably be required to give a good natural match.
Enlarge the remaining breast
Breasts containing implants have different characteristics to natural breasts. They are fuller and firmer, particularly in the upper half of the breast and are less affected by gravity over time. If a woman would like to have larger and firmer breasts, this can be achieved by augmenting the undiseased side with an implant and matching the new size and shape with an implant based reconstruction, either alone or with a Latissimus Dorsi flap.
How it is done
Breast augmentation involves making an incision about 7 centimetres long either in the fold under the breast, around the nipple or in the armpit. The fold under the breast is the most common site. A pocket is made for the implant either between the breast tissue and the 'pec' muscles, or under these muscles and the implant is inserted. The wounds are then closed, generally with dissolving sutures. A drain may be used for a few days.
Reduce the remaining breast
Breast reduction or reduction mammoplasty can dramatically alter the size and shape of large, droopy breasts. Large breasts can cause breathing problems, pain in the back, neck and shoulders, heaviness in the breasts themselves and sweatiness, rashes and pain in the creases below the breasts and low self-esteem. Large breasted women often have few options when it comes to reconstruction, as large breasts require a large volume of tissue, generally only available using a TRAM based technique. For women with symptoms due to breast size, reducing the remaining natural breast can not only alleviate these symptoms, but requiring a smaller volume of breast to reconstruct can widen the range of options for reconstruction.
How it is done
Breast reduction involves removing excess fat and skin from the lower part of the breast, moving the nipple to a higher position on the mound and then suturing the breast back together. Generally the procedure is performed through an 'anchor' incision. A cut is made around the areola (darker skin around the nipple), vertically down the breast from the bottom of the areola to the fold under the breast and along the fold under the breast. The breast is then opened and the excess breast tissue, fat and skin is removed. With the lower tissue removed, skin from the sides of the breast is brought down and together resulting in a smaller and firmer breast. The nipple is then repositioned in the appropriate place on the breast, drains are inserted and the wounds are closed, generally with dissolving sutures. Another technique (LeJour pattern), suitable for smaller reductions, avoids the scar under the breast fold.
Lift the remaining breast
Over time, gravity has an effect on all breasts. As the breast tissues become less elastic, breasts hang lower on the chest, the nipples hang lower on the breasts and the areolae (darker skin surrounding the nipples) become larger. A breast lift or mastopexy adjusts the shape and position of the breast and nipple without changing the size of the breast. Women with 'droopy' breasts may take the opportunity of reconstruction to undergo a breast lift on the unaffected breast, and a reconstruction to match the new shape and position. Women with small but sagging breasts, may combine mastopexy with breast augmentation resulting in larger and firmer breasts.
How it is done
Mastopexy is a very similar operation to breast reduction except that only excess skin is removed rather than breast tissue, fat and skin. In this procedure, as with reduction, the breast is opened through an 'anchor' or LeJour pattern. The excess lower breast skin is removed and the sides of the breast are brought down and together resulting in a firmer and higher breast. The nipple is then repositioned in the appropriate place on the breast, drains are inserted and the wounds are closed, generally with dissolving sutures.
Remove the remaining breast and reconstruct both breasts
Women at high risk for breast cancer may decide that it would be preferable to remove all of their breast tissue so that they do not need to worry about breast cancer in the future. For these women, mastectomy on the undiseased side as well as the affected side may be the best option. From the reconstructive point of view, creating symmetrical, matching breasts can be achieved relatively easily with any reconstructive technique, but reconstructing both breasts with tissue flap techniques requires an even longer operation than for one breast.