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Shaping the Opposite Breast

Shaping the Opposite Breast, Breast Reconstruction

Guiseppe Bartolomeo Chiari, Bathsheba at Her Bath, The Metropolitan Museum of Art

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John Q. Cook, M.D.

Chicago 312-751-2112
Winnetka 847-446-7562

Shaping the Opposite Breast with One-Sided Breast Reconstruction

For many patients it is important that the reconstructed breast and the natural breast have a similar size, position, and shape. In order to achieve this I will select from a portfolio of techniques and design an operation that is suited to your needs. In two-stage reconstructions I will usually shape the opposite breast at the second operation, in which I remove the tissue expander and place the permanent implant for the reconstructed breast. There are some surgeons who like shaping the opposite breast at the time of placement of the tissue expander.

Breast implants can help to balance the reconstructed breast with the opposite natural breast, particularly in the upper pole. Natural breasts tend to become somewhat hollow in their upper portions with the passage of time. Reconstructed breasts will have a greater degree of upper pole structure, even if I use form-stable implants. An implant on the side of the natural breast will help make the upper portions of the breasts more balanced and stable over time. If the natural breast has become deflated due to life events such as weight fluctuation or pregnancy, a breast implant will restore tone. This can work well as long as the structure of the breast is not too settled. Otherwise, a breast lift may be necessary in addition to the implant.

BREAST REDUCTION TO BRING A LARGE, HEAVY BREAST INTO BALANCE WITH THE RECONSTRUCTED BREAST

Reconstructed breasts tend to have a compact structure and are limited in terms of the realistic size that can be achieved, especially with implant reconstruction. If the opposite breast is heavy and settled, the imbalance between the two breasts will upset body mechanics and lead to significant back discomfort. Breast reduction will help to bring the two breasts into a better balance and is an important part of breast reconstruction surgery. The reduced breast will respond more to body weight fluctuations than the reconstructed breast, and it will settle to a lower position as time passes, so it may be necessary to do additional surgery with the passage of time.

DIFFERENT BREAST LIFT TECHNIQUES PRODUCE DIFFERENT BREAST SHAPES

Periareolar Mastopexy works well for pointed breasts that need just a little lift. This technique produces a more rounded breast, which is a better match for the fundamental shape of a reconstructed breast.

Classical Breast Lifts can work well in breasts that are very stretched out in their lower portions with a great excess of loose skin.

Structural Breast Lifts provide an ability to restore volume to the upper portion of the breast without implants. As we plan the second stage of breast reconstruction I will analyze the structure of the natural breast and review the implications of different lift techniques on breast shape and balance.

BREAST LIFT COMBINED WITH AUGMENTATION FREQUENTLY HELPS TO HARMONIZE THE TWO BREASTS

Very often the patient will benefit if I lift the opposite breast and add volume behind the entire breast structure. I place the implant in the plane under the pectoral muscle. A natural breast that is treated this way will have a structure that is closer to that of the reconstructed breast, and the two breasts will behave similarly as time passes.

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