How to even out breasts after cancer?

Hello, I had breast cancer in my left breast, treated with lumpectomy and radiation. Now my right breast is a C cup and my left breast an A cup. Can my right breast be reduced and lifted by an areola incision? Thank you.

user1511817

F, 63, California

Uneven breasts are a common cause of poor self-esteem and reduced quality-of-life after radiation treatment and lumpectomy. The short answer is yes: Reducing your larger breast to be an equal cup size to your smaller breast can be accomplished.

The far more difficult task, however, is getting both breasts to look perfectly symmetrical.

Plastic surgeons need to be open and honest with their patients about the prospects of restoring a patient's original breast symmetry. The goal is to make them as symmetrical as possible, but the outcome will in all likelihood never be perfect.

Not only will it often take several procedures to achieve the same size and shape for both breasts, but it will usually require additional surgeries in order to maintain that symmetry over time.

Surgery to make both breasts symmetrical requires a surgeon with extensive skill and experience. My best piece of advice is to meet with more than one plastic surgeon and choose whoever has a solid history of successes. Be sure to carefully review their gallery of before and after photos and patient reviews. Remember, you are paying for skill and expertise not a generic procedure.

Always remember to choose a board-certified plastic surgeon for best practices and best results.

Reconstructive surgery via an areolar incision is not a complicated procedure. Achieving perfect symmetry between the right breast and the left breast, however, can be very challenging even for the most experienced plastic surgeons.

Because of the difficulty of the procedure, it's important to set appropriate expectations when considering plastic surgery to correct asymmetrical breasts: Although the goal is to come as close to symmetrical as possible, achieving 100% symmetry is not feasible as no two breasts are ever completely symmetric. Furthermore, achieving close symmetry may require multiple procedures. It is also very unlikely that a reconstructed breast mound will age identically to a natural breast over time. As a result, you will likely need future procedures in order to correct additional asymmetry that develops over time.

Although it may seem logical to perform breast surgery on just one breast, in many cases it is easier to achieve breast symmetry by surgically adjusting both breasts. Due to the inherent complexity of correcting breast asymmetry, I would advise you not to shop for a specific technique but to follow the surgical recommendations of your plastic surgeon.

Every patient is different and there are many possible reconstruction techniques that can be used to achieve your goals. These techniques include tissue expanders, latissimus flaps, TRAM flaps, DIEP flaps, fat transfer, and others. After an initial consultation, an experienced plastic surgeon will know specifically which procedures and approaches offer the best chances for a symmetrical and natural-looking outcome in your specific case.

I can't give you any specific advice without a direct examination, but I do advise you to be diligent in your search for an experienced plastic surgeon with a history of successful breast reconstructions and satisfied patients. 

Patients with breast asymmetry following cancer treatment should be aware that returning your breasts to their former symmetry is extremely difficult to do, and will likely require multiple additional tissue reconstructions, lifts, and touch up surgeries.

Reduction of the larger breast is generally an easier way to achieve breast symmetry than by inserting an implant in the smaller breast. Placing an implant in the smaller breast in order to match the size and contour of the bigger breast can be nearly impossible.

Also, if a high level of symmetry is your goal you should be prepared for many years of follow-up procedures. Aging, the effects of gravity, and changes in body weight will affect both of your breasts very differently in the years to come. The level of symmetry you achieve now may look very different a few years from now.

Following your plastic surgery, you won't be able to tell how symmetrical your breasts are for some time. The final size and contour of your breasts won't be visible for two to three months following your surgery.

Immediately following the procedure, you should plan on a week or two of downtime relaxing at home. You should also plan on not being able to drive for at least a week as well. It's normal for your breasts to have small lumps where there are internal sutures. The sutures will eventually absorb and disappear, and the lumps will eventually vanish on their own.

The most important step in correcting your breast asymmetry is your selection of an experienced, board-certified plastic surgeon. Be sure to review before and after photos of your surgeon's previous work, and to select a surgeon with a good sense of aesthetics, proportion, and contour. To answer your question about an areolar incision: Yes, this is possible, but I would follow your plastic surgeon's advice regarding which techniques make the most sense for your particular case.

That's a great question and it's often a very humbling one for many breast surgeons. There is no simple solution to correct uneven breasts after radiation treatment and lumpectomy. Getting breasts of different sizes to match perfectly can be very difficult.

Every case is different, and the likelihood of a perfect aesthetic outcome depends on a number of factors including relative breast size, the skill of the plastic surgeon, and your willingness to undergo multiple procedures in order to achieve your goals.

My advice is to consult with a plastic surgeon who has a long history of experience with breast augmentation and breast reduction surgery, and a successful track record of correcting breast asymmetry.

While "perfect symmetry" is always the objective, it is very rarely achievable, especially after just one plastic surgery procedure. In the vast majority of cases, follow-up procedures will be necessary for small adjustments.

Over the long term, the effects of aging, weight gain/weight loss, normal growth variations, and gravity will affect each breast differently. Depending on how high a bar you set for your personal aesthetic goals, you should also be prepared to undergo follow-up procedures years from now in order to maintain breast symmetry over time.

Correcting breast asymmetry is often more of an ongoing process than a single corrective surgery.

Yes, this should not be a hare thing to accomplish.  Although it is very difficult to achieve perfect symmetry to your breast that was radiated, the other breast can be made smaller and lifted so that it is much closer to the same size.  Meet with a PS who does a lot of breast reconstruction to get a better idea of your options.  The surgeon who did your lumpectomy can probably give you a recommendation of which PS to see.  Best of luck