Symmetry Surgery on the Opposite Breast

(Post-mastectomy Contralateral balancing surgery)

The reasons for contralateral (opposite breast) symmetry surgery:

You might want to consider balancing surgery on the opposite breast purely for the purposes of improving symmetry for a number of reasons. Contralateral breast surgery in patients undergoing unilateral breast reconstruction can be looked at simplistically as falling in two groups.

First are those patients in whom the surgery on the opposite normal breast improves the situation that the patient might have requested plastic surgery for anyway even without the diagnosis of breast cancer: symptomatic large breasts, significantly small breasts, deflated and droopy (atrophic & ptotic) breasts. These patients often see these contralateral balancing procedures of breast reduction, breast enlargement and breast lift “as somewhat of a silver lining in the cloud of breast cancer” (Scott Spear, 1998, Washington DC). Some patients have an unattractive opposite breast and adjustment of its shape and size is welcome because matching it would produce two unattractive breasts. It is important that you communicate to Professor Malata your own desires or concept of the ideal breast as this is an important consideration in symmetrization surgery.

In the second group, contralateral balancing surgery is undertaken to correct the deficiencies of the reconstruction or it is more practical to alter the normal breast than the reconstructed one. They include breast lifts or reductions to complement a contralateral implant reconstruction, reductions to match an implant reconstruction or even a TRAM flap reconstruction if the TRAM does not provide adequate volume. A reconstruction that is too big and therefore requires contralateral augmentation may also fall into this category.

Closely related to these two groups are the prophylactic mastectomy patients. You may wish to have an elective mastectomy and reconstruction because of a strong family history of breast cancer or possession of the breast cancer gene mutation. In addition young women who are likely to be cured of their early or non-invasive breast cancer, often are very concerned about the other breast. The decision about the appropriateness of a purely preventive mastectomy needs to be reached by you and your oncologist and breast surgeon. If you are considering such a risk-reducing mastectomy you must inform Professor Malata during the consultation with him so that he can assess you for breast reconstruction of both breats at the same time.

Timing of contralateral symmetry surgery:

Balancing surgery on the opposite breast can be performed at the same time as the reconstruction (simultaneous) or sometime after the reconstruction (sequential). Professor Malata prefers to undertake balancing surgery on the unaffected breast at the same time as the reconstruction in line with most patients’ wishes. Its advantages and disadvantages are similar to those of immediate breast reconstruction (link to Pros and Cons of IBR). Proponents of sequential symmetrization surgery however argue that their approach allows the reconstruction to “settle” and stabilize before contralateral balancing surgery. It mayalso be indicated in patients who are not fit to withstand a larger operation and staggering the balancing surgery reduces the procedure to 2 smaller operations.

Symmetrization Surgery Options

For breast reconstruction the options available for contralateral breast symmetry surgery include:

a) breast reduction (reduction mammaplasty),

b) breast enlargement (augmentation mammoplasty)

c) breast lift (mastopexy),

d) combined lift and enlargement (augmentation-mastopexy),

e) prophylactic mastectomy with immediate reconstruction.

f) capsulectomy and implant exchange: in patients with previous cosmetic breast augmentation before they developed breast cancer.