Ask. Dr. Barber

Q. When I was 39 years old (12 years ago), I had breast cancer and had a mastectomy with immediate reconstruction using tissue from my tummy. My reconstructed breast is doing just fine but my problem is that over the last 12 years I have gained some weight and my natural breast is now larger and droopier than it used to be. So unfortunately, my breasts do not match anymore. Is there a way to make them more symmetrical? I am very self-conscious when I put a bathing suit on because the difference is very noticeable.
A.  First, congratulations on 12 years of beating breast cancer. This disease which has plagued women (and to a lesser extent men) since the beginning of time is so treatable when caught early. You are proof of that. Regular exams by your doctor, regular self-exams and screening mammograms are so important to early diagnosis and cure of this disease. As for your question, yes, there is definitely a solution to the asymmetry that you have developed over the last 12 years. Your problem is not that unusual, and I have seen it many times. The problem is that a reconstructed breast does not respond to the aging process and weight gain and all the changes that take place over time, the same way as a natural breast. In your situation, your natural breast has developed all the issues that a mature breast can, that is sagginess, and in your situation, an increase in size due to weight gain. So to solve this problem, I would use your reconstructed breast as the model for size and position and simply lift and reduce the volume of the natural breast to more closely match the reconstructed breast. The surgery is an outpatient procedure. You can expect to be out of commission for about 1-2 weeks, meaning no driving and no vigorous activities. Obviously there will be some scars on the natural breast, but most patients are accepting of the scars in order to gain symmetry. The good news is that this procedure is covered under private health insurance and Medicare. The surgery is considered a symmetry procedure in a patient with a history of breast cancer and therefore insurance coverage is mandated by federal law. Just a word of advice, although you can expect significant improvement with respect to symmetry, your reconstructed breast and your remaining natural breast will never look perfectly symmetrical.  A reasonable expectation should be that they look good in clothes and even a bathing suit, but there will always be some differences that just cannot be corrected.

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