By William Byron Barber II, M.D.

Q. Twenty years ago I was diagnosed with breast cancer. I was treated with a lumpectomy, radiation therapy to my breast and chemotherapy. At the time, I thought my breasts looked OK after my treatment and I never did any reconstruction. Now, 20 years later, the side that I had the lumpectomy and radiation done is at least a cup size smaller than the unaffected side. It is impossible to find a bra that works, and I hate putting a bathing suit on because it is so noticeable. My question is whether it is too late to fix the small breast and make it look more normal?

A. As long as your health is good, then it is never too late to perform surgery to produce better symmetry of your breasts. You did not state your age, but age really does not matter as long as you are in good health. The description that your breast progressively got smaller over the years following treatment for breast cancer is not that unusual. There are likely 2 reasons why this happened. First, the surgeon did take some of your breast tissue out when the lumpectomy was performed. That alone will give you slight size reduction. Second, and likely the more important reason, is that the radiation therapy to a breast frequently causes progressive atrophy or shrinkage of the remaining breast tissue, which can continue for years after the therapy has been completed. After 20 years, however, I am pretty sure that the shrinkage has stopped so you do not have to worry about the process continuing. In order to figure out the best route to correct the asymmetry, you must first decide whether you like the size of the larger breast or the smaller breast. If you like the size of the larger breast, then an implant can be placed in the smaller breast and that will improve the symmetry. If you like the smaller breast, then a breast reduction on the larger side is the treatment of choice. On occasion, the best option is to address both breasts in order to maximally improve the appearance and symmetry. For example, you may benefit by doing a reduction on one side and a breast lift and implant on the smaller side. An important point that you need to be aware of is that since the asymmetry was cause by treatment for breast cancer, insurance will cover the cost of the surgery. I would suggest that you see a board certified plastic surgeon who is an experienced breast surgeon and discuss your particular issue and your goals. I have no doubt that your problem is fixable. Good luck.