Minor corrections after reconstruction
The breast reconstruction process usually requires more than one surgery to achieve the final result. After the initial breast mound is created, subsequent surgeries work to refine the shape of the breast, improve symmetry, or restore normal breast characteristics such as the nipple and areola.
The ultimate goal for breast reconstruction is to create a breast that’s symmetrical to the remaining natural breast. And while excellent cosmetic results and symmetry can be achieved with surgery to the reconstructed side alone, performing an operation on the healthy side can improve overall cosmetic results.
From a surgical perspective, reconstructing both breasts after mastectomy is typically better for achieving breast symmetry. Here the surgeon is essentially starting with a clean slate and doesn’t have to match the newly reconstructed breast to an opposite, natural breast.
One-sided breast reconstruction, on the other hand, makes symmetry a bit trickier, as it can be difficult to match the natural droop of the unaffected breast. If you have large breasts, you may need a reduction of your opposite breast in order to match the reconstructed breast. If you have smaller breasts that sag, you may need a lift of the natural breast or augmentation with an implant to improve the shape and facilitate symmetry.
SOME OF COMMON PROCEDURES USED TO ACHIEVE BREAST SYMMETRY
Breast lifting and reshaping (mastopexy)
If your natural breast is more droopy than the reconstructed breast it can be lifted and reshaped. Commonly referred to as breast-lift, this procedure raises and firms the breast by removing the excess skin and tightening the surrounding tissue to reshape and support the new breast contour.
In this breast-lift procedure, the breast size isn’t altered, but the breast droop is corrected by lifting the breast to give it a more youthful shape and higher position on the chest wall. This procedure is particularly helpful for mastectomy patients who’ve lost a significant amount of weight or who’ve had multiple pregnancies.
Breast reduction (mammaplasty)
If your natural breast is larger than the reconstructed breast it can be reduced in size and altered in shape so that the final appearance is balanced. Breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size matching the reconstructed breast.
Breast enlargement (augmentation)
If your reconstructed breast is larger than your other breast and you prefer the larger breast, the natural breast can be made bigger with a silicone implant. This can sometimes be combined with a breast lift. By placing an implant under the breast it’s made bigger to match the reconstructed breast in size.
Some mastectomy patients, especially younger ones with small breasts, elect to have opposite-breast augmentation to achieve a slightly fuller breast volume that matches the reconstructed breast.
The majority of mastectomy patients who have breast reconstruction surgery also have nipple/areolar reconstruction. Nipple reconstruction gives the breast a natural appearance. It’s a relatively simple procedure that’s done on an outpatient basis under either sedation or a light general anesthetic. Nipple reconstruction may involve using local tissue from the reconstructed breast or sharing tissue from the opposite normal nipple. This tissue sharing procedure provides the best color and texture match with the opposite breast, but the patient has to have adequate nipple tissue on the opposite breast and be willing to have the opposite nipple used.
The areolar (the pigmented skin surrounding the nipple) is reconstructed with a skin graft from one of several sites. Donor sites for areolar grafts will vary with each patient depending on color match and patient preference. Generally a site that has some degree of color match with the opposite breast areolar area will be selected. The most common sources for the skin graft are the groin crease, the lower abdominal wall skin and, sometimes, the extra skin along the outside of the mastectomy scar.
Once the nipple/areolar reconstruction is completed and healed, a simple in-office tattooing procedure can help gain the best color match. This tattooing is a relatively painless and simple procedure and, for some patients, may be substituted for areola grafting.
Finally, in some patients, a small implant may be placed under the completed nipple/areolar reconstruction for additional projection.