Breast Lift of Good Breast After Unilateral Mastectomy?
- Asked by trchr in Chicago
- 4 years ago
I'm 35 years old and in two weeks, I'll have Mastectomy of left breast and immediate Breast Reconstruction with implant-expander. The PS told me that my right breast (the good one) needs just 2 cm lift which he will do with crescent lift. The second option is to put a small implant and increase size a little bit.
What do you think? Which procedure would have the best result (more symmetric breasts) in my body (my chest is skinny as you can see in the pic) for now and in the future? Thank you in advance.
Post-mastectomy breast reconstruction
I am sorry to heat the you have breast cancer. From the photo you posted, it is difficult to say what to do specifically for the right one. Other photos veiws would be helpful, but it really does not look like you need anything on that side. If it is sagging a bit, then a small implant may do the trick.
Immediate breast reconstruction and options for normal breast
Achieving a good breast reconstruction is more similar to completing a work of art. There is no formula or recipe or definitive step by step process.
Some of these appraoches have been discussed.
It is difficult with any implant breast reconstruction to achieve a natural "droop" to the breast. Despite the best of our intentions, the implant reconstructed breast tends to have a full non-sagging appearance.
To this end, knowing that the left will have a full appearance with a relatively high riding nipple, performing a crescent lift on the normal side is a reasonable option.
Breast lift as part of breast reconstruction
Breast lifts as a way of balancing the breasts after mastectomy and reconstruction are very common, but the key is the timing of the procedure. Looking at your photos, I would be very surprised if you need much of a lift on the right side, if any, and I would definitely not touch the right breast until we know exactly what the size and shape of the left side will be-- this is hard to predict before the mastectomy, so waiting is often the best option.
The choice to do an immediate versus delayed reconstruction is a personal one, and some surgeons only do one or the other-- as a group we're divided on this issue for a lot of reasons, but assuming your doc feels that you are a good candidate for this, I think it can be done.
My usual plan in these situations is:
Procedure 1: Use of a tissue expander with the skin substitute Alloderm on the left side, performed as the first stage of the reconstruction at the time of the mastectomy (this is called an immediate reconstruction, and while many patients are not good candidates for it based on their anatomy, I think you are, as long as you don't have a high chance of needing radiation after the procedure). The Alloderm acts as a sling to hold the expander in a nice position, and is placed under your skin.
Your expander is filled with saline each week or two to expand it, creating the size and shape of a breast.
Procedure 2: On the left side, we would remove the expander and place a soft implant, usually a silicone gel implant. At this point, we will know what your right side needs in order to get you the best balance: a lift, an implant, a lift plus implant, or maybe even nothing. (this is an outpatient procedure-- no need to stay overnight in the hospital)
Procedure 3: Creation of a nipple on your left breast-- this can be done in the office with just some numbing medicine; this nipple can be tatooed later on to match your right side.
I hope that helps-- talk to your surgeon carefully before agreeing to have anything done on the right side and find out what the goals of that procedure would be.
Web reference: http://www.drsalemy.com
Recent Breast Reconstruction Reviews
Breast Reconstruction Photos
Symmetry is one of the primary goals of reconstructive surgery.
Achieving symmetry between the reconstructed breast and the contralateral breast is one of the main goals for a successful reconstruction, and it is also one of the biggest challenges. It is not at all uncommon to perform a breast reduction or a breast lift with reconstruction, or include an implant on the opposite breast in order to create a more even, natural appearance. If you have doubts about your surgeon’s suggestion, remember that you always have the option to ask that the breast lift wait until after you have seen the final results of reconstruction instead of getting everything done all at once. Of course, this is a personal decision, and only you can decide what will work best for you.
Managment of the contralateral breast in breast cancer
At 35 years old, I would think long and hard about proceeding to a double mastectomy rather then a unilateral if you are not going to do an autologous reconstruction of you breast (the best choice for a unilateral reconstruction in younger patients). With the choice you are making, you will be embarking on a long journey of multiple surgeries chasing an elusive asymmetric shape you're going to produce while still having to doing extraordinary close surveillance for breast cancer of your other breast.
By definition, a 35 yo breast cancer patient is among the highest risk for subsequent cancer of the other breast over your lifetime. To me, maximum risk reduction and the better symmetry make a compelling argument to so a bilateral mastectomy
Breast lift on opposite side after breast reconstruction
Your breasts are asymmetrical but trying to guess exactly what procedure will be needed is difficult to assess until after your mastectomy and breast reconstruction. I usually wait until the second procedure when I am placing the permanent implant before I decide exactly how I want to shape the opposite breast.
Contra lateral breast surgery for symmetry Ivan be done later
There is no reason to do any surgery on the right breast at this time. Control the shape and size of the left breast is the is sure after your mastectomy. Good luck with your surgery.
Contralateral procedure following mastectomy
Thank you for the question and the photo...I hope that these answers will assist in your decision. A surgical procedure on the contralateral (opposite) breast is a very common thing to do for women who have a mastectomy on one side only. It is not uncommon to have asymmetry following the mastectomy, for which a mastopexy (breast lift) or an implant would do well to correct the issue. Both of these are relatively similar procedures, but very effective for this problem.
Looking at your photo, it appears that your right nipple is at an adequate position and would require a very small breast lift, if any. If you were to have an implant-based reconstruction, your reconstructed breast would be more perky, fuller, and rounder than your unaffected breast. Often times when an implant is chosen for the reconstructed breast, I recommend placing a small implant, just to give a more symmetric appearance by use of the implant and give those aforementioned properties. I would say that this may be the better option for your case. A discussion regarding the options with your plastic surgeon should include all of these and together you should make the decision for which option, if any, is best for you. Good luck!
Web reference: http://www.albertandresmd.com
Opposite Breast Balancing Breast Lift after Reconstruction
A crescent lift is a reasonable option for small adjustments of the nipple areolar positon.
However the timing would be best to first have the implant placement following tissue expansion, then let things settle down for some months. At that time a crescent balancing mastopexy (lift) can be performed if needed - often times as an office procedure under local anesthesia and/or IV sedation.
Breast lift versus implant
First focus on becoming cancer free! A breast left would help but the real question is if you are happy with your breast size now. If not then you can get an augmentation on the normal side and have the tissue expander on the cancer side normal match for size. The other alternative is to just have the tissue expander placed in the size you will be happy with and have the augmentation/lift decision made at the time your tissue expander is swaped for a permanent implant. That will give you the closest size match.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.