Posted by Dr Chris Porter on Mar 23, 2018
Breast asymmetry after breast cancer surgery such as lumpectomy, wide local excision or partial mastectomy is common. Typically the breast that was treated for breast cancer ends up being smaller and sometimes shape distorted due to the breast tissue removal. This outcome can be exaggerated if radiotherapy was also used. It is important for breast cancer patient to undergo all recommended cancer treatment, as survival is the primary goal, and consider breast cosmesis as a secondary concern.
When Can Breast Asymmetry be Corrected?
Not all breast asymmetry needs to be corrected, subtle shape or size differences are normal and accepted by most women. If the difference between the two breasts is significant then surgical correction can be considered. To be obvious and concerning to the patient the breast asymmetry may only be half a cup size difference or greater in small breasts or at least one cup size in larger breasts. It can take 6 months after surgery for the breast to settle into its final form and size, if radiotherapy was given it can take 12 months. It is advisable to wait this time before considering surgical correction.
How Can Breast Asymmetry be Corrected?
Depending on patient desires and characteristics then there are a number of surgical options available.
It is possible to treat only one breast to gain volume symmetry:
- the smaller breast can be augmented with an implant or autologous fat transfer.
- the larger breast reduced.
If both breasts are to be treated to gain volume symmetry, then:
- both could be augmented with different size autologous fat transfer or implants.
- both could be reduced with different volume reductions.
- one breast could be augmented and the other reduced to gain a new breast size intermediate between the two asymmetric breast sizes.
- if there is a significant shape asymmetry then a lift can be added to either the augmentation or the lift to optimise the breast shape as well as the breast volume.
Can Breast Asymmetry be Avoided?
In the multidisciplinary breast cancer team there will be a breast cancer surgeon who will be able to accurately define the volume of breast tissue to be removed and a plastic surgeon who has a toolbox of flap options to immediately fill the volume defect at the time of the lumpectomy. This enables any potential asymmetry to be detected pre-operatively and avoided. In my experience this works very well in women who are a C cup or larger and are willing to undergo a breast reduction to both breasts. The recovery from this is similar to the lumpectomy alone and has the silver lining of providing a lifted and improved breast shape compared to most women’s pre-operative breast shape.
Every patient is different in their desires and these need to be well matched to their physical characteristics and the surgical options mentioned above. I would advise you to seek a consultation with a plastic surgeon experienced in breast surgery, they will guide you through your options to get the best possible breast symmetry.