Breast Lift of Good Breast After Unilateral Mastectomy?

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.

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!

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. 

Expander implant reconstruction means that your breast will be reconstructed in stages over time.   This means that your reconstructed breast will change in shape and size during the course.   It would be very hard to plan an appropriate "mastopexy" of your right, normal breast until the left side is completely healed and settled.   Why?  The mastopexy design will be dependent upon the overal result of the left breast.   It would be better for you to wait on the right breast until 3-6 months after the final procedure is completed on your left.  This will be your best chance at symmetry.

Thanks for the great question.
The simple answer is it is too early to be able to tell the best answer. Most symmetry operations after mastectomy and reconstruction are staged. This gives time for the reconstruction to settle and find its final shape as well as give you more of a chance to see what you desire and need for symmetry.
While multiple surgeries means a longer reconstruction process typically it produces greater cosmesis.
Typically "crescent" lifts have minimal power in truly lifting the breast.
Your insurance company should cover any symmetry procedures to the normal breast.
Take care of the cancer and the immediate reconstruction and then evaluate the overall shape and create a plan six months after your reconstruction.
I hope this helps.

I think that Dr Salemy's answer is very well thought out and expressed well. I don't think I would do anything differently and I do about 5 or 6 breast reconstructions a week.
Good Luck,
Dr T

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.
Good luck,
Dr. Salemy

You may or may not need a surgery on the unaffected breast.  We can often create a very natural looking reconstruction, especially if the nipple is spared.  I often find that with a nipple sparing mastectomy, I can position the nipple in a more symmetric location.  If you do require symmetry surgery, it may be in the form of a crescent lift, fat grafting or a small implant (if you want to go bigger).  Wait and see.  You have options.

From your photo, it appears that you do not have much ptosis (droopiness) of your right breast. I would see how the reconstruction looks without operating on your right breast before making a permanent decision. After several months, the left breast will drop after the breast reconstruction, so you may not need to do anything at all to the right breast.

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!@norrisplastic