Bilateral breast mastectomy and reconstruction provides improved cosmetic results since it ensures symmetric breast composition. One of the questions that I get routinely, is whether undergoing prophylactic mastectomy of the uninvolved breast along with reconstruction instead of only a unilateral breast mastectomy and reconstruction is beneficial to patients from a cosmetic standpoint.
As you all know, whether a patient may have indications to undergo a prophylactic mastectomy of the uninvolved breast or not is determined by your plastic surgeon. This consideration is ultimately made by your breast cancer surgeon and oncologist. It is also dependent on your family history of breast cancer and whether or not you test positive for the breast cancer gene.
The question that I am asked is specifically whether undergoing a bilateral breast mastectomy and reconstruction provides any benefit from a cosmetic standpoint. The answer to this question is an overwhelming yes. The reason for the improved outcomes when you have both breasts treated with mastectomies and subsequent reconstruction is that both breasts will be composed of equal proportions of breast implant and breast tissue.
This is in comparison to undergoing unilateral breast mastectomy and reconstruction where one breast is mostly implant and very little breast tissue versus the uninvolved breast that will be mostly if not entirely composed of your own breast tissue. When such a variance in breast composition is present, the breasts will naturally look different from the get-go. Unfortunately, as these breasts continue to age, they will become even more different in appearance.
This is because gravity will affect each breast variably and typically the uninvolved breast will continue to droop more aggressively than the reconstructed breast. Although we are not sure why the breast with the implant tends to be more resistant to sagging with age than the uninvolved breasts. This means that as you age, the uninvolved breast continues to droop when compared to the treated breast.
What this means for our unilateral breast reconstructed patients, is that they are seen over a few years to undergo a lift procedure on the uninvolved breast. In contrast, patients who undergo a similar breast mastectomy and reconstruction on both breasts tend to maintain symmetry and resist sagging altogether.
Please consider a breast consultation if you have been found to require a breast mastectomy so that you can be evaluated and educated on the differences in cosmetic results between a unilateral versus bilateral mastectomies and reconstructions.
Please appreciate this female who chose to undergo bilateral breast mastectomies and subsequent reconstruction. She required immediate reconstruction with expander and allograft which was then completed with expander/implant replacement and bilateral nipple and areola reconstruction.