Reconstructive Surgery

Opposite Breast Balancing Surgery

(Contralateral Balancing Procedures)


Opposite breast balancing surgery in breast reconstruction mainly consists of breast reduction, breast lift, breast augmentation or combined breast lift & augmentation. The principle can be extended to patients having a “preventive” mastectomy on the opposite breast and its immediate reconstruction in order to improve symmetry Although in most patients breast reconstruction after mastectomy produces excellent cosmetic results without balancing breast surgery on the opposite breast, many (single-sided) breast reconstructions require a balancing procedure on the opposite breast in order to achieve symmetry; which is the ultimate goal in breast reconstruction. Given the choice many patients prefer to leave their unaffected breast “untouched by the surgeon’s scalpel” (John Bostwick III, Atlanta, Georgia). The options available for contralateral breast symmetry surgery include

a) breast reduction,

b) breast augmentation,

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.

The goal of any symmetry procedure is to match as close as possible the two breasts in terms of size, shape, projection and nipple-areolar position. The choice of the balancing procedure depends on your breast size and shape, the type of reconstruction being undertaken, the mastectomy type and, to a lesser extent, your preferences. Many patients correctly seize the opportunity to improve their breast shape and size at the time of mastectomy and reconstruction.

If at all you wish to improve your existing overall breast appearance or are unsure whether it would be appropriate, it is very important that, during the consultation, you mention this to Professor Malata who will fully discuss your request for balancing breast surgery and if necessary please consult your oncological breast surgeon especially for those seeking a prophylactic mastectomy.


Advantages of symmetry surgery on the opposite breast:

  • Optimises cosmetic result by improving the match with opposite breast (size, shape & projection)

  • Improves originally “unattractive breasts” (droopy, too large, too small, deflated)

  • Can reduce the size of the reconstruction needed for larger breasts – simplifies it

  • Augmentation of small breasts enables reconstruction with a wide enough expander

  • Augmentation can match the rounded upper pole of the implant reconstructed breast.


Disadvantages of contralateral balancing breast surgery

  • External scaring on the opposite breast: reduction more than augmentation

  • Internal breast scarring: may influence future breast screening

  • Position of the implant has to be under the muscle: to reduce interference with mammography

  • Cost implications: Insurance coverage

  • NHS waiting list pressures: theatre time limitations

  • Patient’s refusal to have surgery on their normal breast.

  • Complications of this extra surgery.

To view the before and after pictures in Professor Malata’s publications which highlight balancing surgery on the opposite breast click here

  • An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars results from a single surgeon’s experience;

  • Multiple Abdominal Surgeries - A valid contraindication to abdominal free flap breast reconstruction?

  • Plastic surgical management of the opposite breast in post-mastectomy breast reconstruction. Part 2: An illustrative approach – in press

  • Early experience with an anatomical soft cohesive silicone gel prosthesis in cosmetic and reconstructive breast implant surgery; )

As in any plastic surgery, there are benefits, risks and the final results are not guaranteed. The chance of complications following symmetrization surgery depends on the type of operation and other factors such as your general health. Professor Malata will explain how the risks apply to you. Detailed postoperative instructions will be discussed during consultation and a procedure-specific handout given to you by Professor Malata.