Asymmetry following lumpectomy and radiation is not uncommon. The lumpectomy removes breast volume, and the radiation causes changes in the breast tissue and overlying skin. The radiated breast typically appears smaller and higher on the chest wall while the non-radiated breast appears larger and remains in its native lower position. There a few breast reconstruction options that can address your problem and may require a combination of techniques. The volume of the radiated breast can be enhanced with either a flap (healthy tissue from elsewhere in the body taken along with its blood supply) or with fat grafting obtained via liposuction. Transferred fat is believed to contain stem cells that also rejuvenates the hard, radiated skin, while a flap replaces the radiated skin with healthy skin from elsewhere in the body. The non-radiated breast can also be reduced in size or lifted with a mastopexy to match the appearance of the radiated/reconstructed breast. I would recommend consulting with a plastic surgeon familiar with the various breast reconstruction options who can tailor your reconstruction to your specific needs.Ziyad Hammoudeh, MD
Each time I have a patient referred to me for this problem we start with a review of the history and any associated problems after surgery or radiation treatment. On exam I am looking for changes in the the nipple position based on where the lumpectomy was performed and the overall change in size secondary to radiation treatment. Exam of the normal breast is used to then help decide options. In some cases a lift or reduction on the normal side restores balance. In other instances I have performed breast augmentation with different sized implants to provide balance again. In this setting I use the photos of the patient and a 3D imaging program to help give the patient and idea of the appearance with different sized implants in an effort to provide balance again.
