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Achieving Symmetry in Breast Reconstruction

First Stage Procedure

Breast reconstruction surgery is ultimately performed to restore symmetry and re-establish an overall aesthetic balance between the breasts. In order to achieve this balance, breast reconstruction is performed in stages and more than one procedure is typically required. The priority of the first stage of breast reconstruction is to preserve the natural shape and structure of the breast, referred to as the breast envelope, while the patient completes oncologic breast surgery, as well as any additional therapy required, such as radiation therapy. Dr. Spiegel will work with you to develop a breast reconstruction plan that fits your needs and oncologic treatment plan. First stage procedures include natural tissue reconstruction or implant based reconstruction. For an overview of the types of breast reconstruction offered by Dr. Spiegel please visit the breast reconstruction overview page.

Second Stage/Symmetry Procedures

The second stage, or symmetry procedure, usually occurs no earlier than 4 months after the initial operation. The reason for this delay is to allow the body time to heal from the prior procedure and to allow time for swelling to subside, ensuring that the shape of the new breast(s) is correct before optimizing the final result. The symmetry procedure is a shorter procedure, compared to the first stage reconstruction, and can be completed as an outpatient. Most patients can resume light activity two weeks after surgery and can resume their normal activity level four weeks after surgery.

The priority for the second stage of reconstruction is to address breast symmetry, and ultimately, achieve the breast shape and size the patient desires. A second procedure is not always required but may be necessary to achieve an optimal result.
Developing a surgical plan to achieve symmetry entails a different decision making process depending on whether the patient is having unilateral or bilateral reconstruction.

From a surgical perspective, bilateral reconstruction (restoration of both breasts after mastectomy) is typically more conducive to achieving breast symmetry. Here, the surgeon is essentially starting with a clean slate and does not have to match the newly reconstructed breast to an opposite, natural breast. Unilateral (one sided) breast reconstruction makes symmetry a bit trickier, as it can be difficult to match the natural slope, or ptosis, of the unaffected breast. For unilateral breast reconstruction patients, it is not uncommon to require an adjustment procedure to the unaffected breast to achieve enhanced symmetry with the reconstructed breast.

Adjustment operations may include one or a combination of the following procedures:

If both breasts were reconstructed, then usually only minor adjustments are required to achieve symmetry. This often includes fat grafting, where fat injections are used to enhance breast contour, soften the breast, and augment the breast by adding volume to improve breast symmetry. Depending on the amount of symmetry refinements necessary, it may be possible to complete nipple reconstruction during this procedure. Sometimes the tension on the breast skin is too great to proceed with nipple reconstruction during the symmetry procedure and if this is the case, nipple reconstruction will be completed in the office as the final stage of your reconstruction.

Though most natural breasts are not perfectly symmetrical, ensuring that the reconstructed breasts are as symmetrical as possible in shape, size, and position tends to produce higher overall patient satisfaction. It is important to note that each patient’s individual reconstruction journey will vary, and the type and number of procedures necessary for optimal results differs depending on individual patient circumstances. Dr. Spiegel will meet with you approximately 34 months after your reconstruction to assess your recovery and work with you to determine if an additional procedure is indicated.

It is important to note that under the Women’s Health and Cancer Rights Act WHCRA additional operations performed on the reconstructed breast or contralateral (native) breast to achieve symmetry are covered by insurance. Our finance specialist will be able to discuss your specific reconstruction and insurance options with you after your symmetry consultation with Dr. Spiegel.

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