Would You Recommend a Lift and Small Implant in the Natural Breast to Provide Symmetry to the Flap Reconstructed Breast? (photo)

I had an immediate left breast reconstruction using the SIEA flap done 4 months ago. I will be planning for the nipple reconstruction and refinements to be done in the next month or so. The reconstruction is definitely 'perkier' than my natural non-cancer breast. Since I like the size/volume of the reconstructed breast, I am looking for opinions regarding a lift and placement of a small implant in the contralateral, natural breast for symmetry. Thanks for your time.

Doctor Answers 5

Next step for reconstruction

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Congratulations, you've had a great result for your first stage of mastectomy reconstruction.  Your plastic surgeon is the best person to make any recommendations for your next step.  But based on your photos, I'd likely suggest a small implant and lift to match your SIEA reconstructed breast.  But again, a physical exam is needed to make any recommendations.  Best of luck.

Dr. Basu

Houston, TX

Breast Implants for Symmetry after SIEA Perforator Flap Breast Reconstruction

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Breast Implants for Symmetry after SIEA Perforator Flap Breast Reconstruction is not common because one of the goals of using your own tissues as in the SEIA peforator breast reconstruction is to avoid the need for implants.

Your right breast is more  ptotic, or hangs down more than your reconstructed left breast. That can be improved with a breast lift provided the volume of the breasts is equal.

I cannot tell for sure whether your right breast volume is lass than that on the left or not.

If it is smaller, then you have two options.  You can revise and reduce the reconstructed left breast, or you can put a  small breast implant in the right breast, with or without need for a breast lift.

The decision can only be made after care physical examination.  My inclination is to avoid the implant option and do the right side breast lift if the volume difference is small.  

If the volume is significantly different, then I would then also revise the left breast reconstruction to make the left breast smaller, and also do the right breast lift so that the shape of both breast would match.  

Fredrick A. Valauri, MD
New York Plastic Surgeon

Breast asymmetry is well corrected without implants.

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The point of doing reconstruction with your own tissues is not to need implants.  So that would not be my first choice.  It looks like all you need is a little lift on the right, as well as modifying the reconstructed breast.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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Asymmetry after Flap Breast Reconstruction

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Firstly, you have a wonderful result. Few surgeons are capable of performing SIEA flaps and yours has done a great job by any standard. You have had the Rolls Royce of breast reconstructions! It is normal to carry out secondary surgery at 4-6 months for balancing, nipple reconstruction and occasionally abdominal scar revision. While, yes, putting an implant on the normal side may initially improve balance, it is my belief that an implant on one side and not the other is a recipe for future symmetry problems. Therefore I would prefer to alter the reconstructed breast (possibly by liposuction) to match the normal one, or perhaps consider fat grafting to the normal breast.

My suggestion to you, though, is to go back to your gifted surgeon and ask what he/she would do if you were his/her spouse/sister.

J. Brian Boyd, MD
Rolling Hills Estates Plastic Surgeon
5.0 out of 5 stars 5 reviews

Matching natural breat to reconstructed breast

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Yes. You would need a lift plus a small implant to match the two sides. I'm not sure what's going on in the armpit area of your reconstructed breast since it is hard to tell from the pictures. But, you may need some fat grafting and/or scar tissue release to smooth out the contour in that area.


Your surgeon did a very nice reconstruction using an SIEA free flap. Usually breast reconstruction is a multi-Stage procedure, as I'm sure your surgeon explained to you. Usually the sequence is as follows. 1. Reconstruct the mastectomy breast (immediate reconstruction preferred since it produces superior results) 2. Lift the contra lateral natural breast to match the reconstructed breast ( with or without an augmentation) 3. Nipple reconstruction 4. Medical tattoo to restore natural nipple/areola color During this process, steps 2 & 3 may be performed simultaneously. Some surgeons may even perform the contra lateral lift at the same time as the initial reconstruction, but it will be much harder to establish symmetry between the two sides if it is done.


Perry Liu, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 5 reviews

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.