The primary purpose of breast reconstruction is to restore symmetry and recreate breasts that are in proportion with the rest of the patient’s body. Even though a woman’s natural breasts may be considered “sisters” and not “twins,” most women would prefer that their new breasts be similar in shape, size, and position to the original. For this reason, it is sometimes necessary to undertake symmetry procedures after the primary breast reconstruction.
Surgically, it is easiest to achieve symmetry in an immediate bilateral breast reconstruction. An “immediate” breast reconstruction occurs when the breast reconstruction takes place in the same operation as the mastectomy. In these circumstances, it is possible to guide the mastectomy so that only the minimal amount of skin is taken. When most or all of the natural breast skin is preserved, it is feasible to recreate the original breast shape.
A “bilateral” breast reconstruction occurs when both breasts are removed. When reconstructing both breasts at the same time, it is easier to match the size, shape, and position of both breasts. Since the surgeon is starting from ground zero, the same type of breast reconstruction can be performed on both sides.
In a “unilateral” breast reconstruction, in which only one breast needs to be recreated, symmetry can be trickier. When only one breast is reconstructed, it is not uncommon to require an adjustment to the unaffected breast to achieve symmetry. For example, if the unaffected breast is “ptotic,” or sagging, it can be difficult to recreate the natural droop of the breast – particularly if an implant is being used. Thus, it may be necessary to perform a “mastopexy,” or breast lift, on the unaffected breast. Likewise, the reconstructed breast may be bigger or smaller than the unaffected breast, and adjustments may need to be made. This can be done with a breast reduction or a breast augmentation, using techniques such as liposuction, fat grafting, or even a small implant when an autologous tissue reconstruction is performed. In general, symmetry is significantly easier to achieve when using natural tissue.
All operations performed to achieve symmetry between the two breasts are covered by insurance. Since breasts are considered a set, the goal of symmetry is considered medically necessary. There are countless ways in which a woman’s individual reconstructive process may vary. For example, a patient with radiated breast skin on one side will have a very different reconstructive experience from a patient who has undergone prophylactic mastectomies due to the BRCA gene. Thus, the specific reconstructive plan for each patient must be individually tailored to her specific history, body habitus, and to her ultimate aesthetic goals.