Achieving balance and symmetry is a vital component in breast reconstruction. To ensure the harmonious appearance of both breasts, it is sometimes essential to address the contralateral breast, often referred to as "the normal side." This adjunct procedure can be driven by various reasons, including significant sagging, distorted contour from previous procedures, or dissatisfaction with the size or shape of the contralateral breast. In this article, we will review the rationale for performing contralateral breast procedures alongside breast reconstruction, the common procedures performed employed, and their impact on achieving a balanced and symmetrical outcome.
The decision to undergo contralateral breast procedures in conjunction with breast reconstruction is based on several factors, all with the primary goal of achieving aesthetic balance and symmetry. Here are some key reasons for considering these adjunct procedures:
1. Sagging (Ptosis)
Significant sagging or ptosis of the contralateral breast can complicate breast reconstruction. It presents a reconstructive challenge to surgeon - neither a sagging but symmetrical breast nor a non-sagging but asymmetrical breast is ideal. The best solution is to address the ptosis of the contralateral breast in the same surgery.
2. Dissatisfaction with Size
Some patients may have always been dissatisfied with the size of their unaffected breast. They may perceive it as either too large or too small and have been wanting to correct them anyways. This is an especially important factor for ladies whom found their breasts too large. It is understandable that they would not want to reconstruct their breasts to the size they never liked.
3. Size restriction from preferred reconstructive option
One of the most common reasons for addressing the contralateral breast is a noticeable size difference between the reconstructed breast and the unaffected breast. A relatively common scenario is a lady who preferred flap reconstruction as she did not want to have foreign material in her body. However, her natural physique of large breast-to-waist ratio means that her tummy (donor region) will not have enough tissue to reconstruct a breast to match her natural size on the other breast. To achieve symmetry, she may opt for breast reduction of the contralateral side.
4. Contour irregularity of "normal breasts"
A variety of contour irregularity may result from previous breast procedures (e.g. biopsy / lumpectomy). The patient may want to address those issues in the same surgery.
COMMON CONTRALATERAL BREAST PROCEDURES
1. Breast Augmentation
Breast augmentation of the normal breast may be performed to improve symmetry and enhance breast size at the same time. If implants are used in both sides, different sizes of implants will be used based on the surgeon's preoperative assessment. Incision is placed on the mastectomy scar on the reconstructed side and usually either in the inframammary fold or around the areola on the augmentation (normal breast) side.
2. Breast Reduction
Conversely, breast reduction is performed when the unaffected breast is larger than the reconstructed breast. The procedure involves removing excess breast tissue and reshaping the breast to achieve the desired size and contour.
3. Breast Lift
A breast lift, or mastopexy, is recommended when sagging or ptosis is evident in the contralateral breast. This procedure involves reshaping and repositioning the breast tissue, and it may also involve repositioning the nipple-areolar complex to a higher, more youthful position.
Contralateral breast procedures play a crucial role in the comprehensive journey of breast reconstruction after mastectomy. Discuss with your reconstructive surgeon the pros and cons of your options, consider personal preferences and comorbidities, and make an informed decision that best suit your needs to optimize the outcome.