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.
PROCEDURE NEEDED FOR SYMMETRY POST MASTECTOMY
Your question may be best answered after your expander has
been placed, expanded, and is ready to be exchanged. It would be easier at that point to recommend
the best procedure to correct any asymmetry between your reconstructed breast
and your native breast. Additionally, it
could be possible that a lift would be needed on the right breast at the time
of the reconstruction on the left to immediately improve the symmetry. Then later when you go to exchange the
expander, an implant could be placed on the right to correct any asymmetry
after the implant is placed on the left. However, without a physical
examination it is difficult to provide a definitive answer to your
question as to whether or not you will need a mastopexy or an implant for symmetry. Keep in mind that breast
reconstruction is a process and can sometimes require numerous operations on
both breasts before an optimum result is achieved.
Congratulations on being a survivor!Be well and good luck!
Symmetry is one of the primary goals of reconstructive surgery.
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.
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.
Breast lift of the normal breast can be done at the same time.
Symmetry procedures don't have to be done at the same time but are routinely done. This should be safe and effective in establishing more symmetry. Please find an experienced Board Certified Plastic Surgeon
and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all
aspects of facial surgery, breast augmentation and body procedures including
tummy tucks or mommy makeovers!
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!
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.