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Breast Reconstruction by Reduction or Lift

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What is a Reconstruction using Local Tissue Rearrangement?


Breast reconstruction via local tissue rearrangement refers to a procedure that rearranges breast tissue after a lumpectomy to create a Breast Reduction or a Breast Lift. This type of reconstruction is an excellent option for women facing breast cancer who do not need a mastectomy, who are candidates for a Lumpectomy and who wish to retain as much of their breast tissue as possible.

The lumpectomy is often done at the same time as the reconstruction, with the Breast Surgeon and Plastic Surgeon working together during surgery (“Immediate Reconstruction”). Alternatively, reconstruction can occur many months to year after a lumpectomy, and can also be done after radiation to the breast (“Delayed Reconstruction”).

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What are the Types of Breast Reconstruction by Local Tissue Rearrangement?

Breast Reduction as Reconstruction

Breast reconstruction using the reduction technique offers the same advantages to breast cancer survivors as women with “symptomatic hypermastia” (excessively large and droopy breasts). Breast reduction is a procedure whose outcome improves quality of life for women and can be life-changing! Excess skin, breast tissue and fat are removed, the nipple is lifted to a higher position, and the areola diameter is usually reduced. A breast lift is always incorporated into the reduction to create smaller and perkier breasts. Please see our Breast Reduction section to learn more about this procedure.

Breast Lift as Reconstruction

Breast reconstruction by way of a breast lift (mastopexy) creates a perkier, lifted, more youthful breast shape. A breast lift rejuvenates sagging breasts to an elevated and more aesthetic position, but does not increase overall breast volume. The final size of the breasts will be determined by the size of lumpectomy and the amount of remaining breast tissue available for rearrangement. Please see our Breast Lift (Mastopexy) section to learn more about this option for reconstruction.

Lumpectomy and Immediate Reconstruction by Rearrangement

Immediate breast reconstruction refers to a single surgery in which both the lumpectomy and the reconstruction are performed at the same time. Breast tissue not requiring removal for cancer is preserved, and the remaining tissue is rearranged (for a breast lift) or reduced (if a smaller breast is desired). Both breasts are lifted or reduced during surgery for symmetry.

Immediate reconstruction by the tissue rearrangement method creates the most natural cosmetic results possible in breast reconstruction, with the very same aesthetic results as a cosmetic breast reduction or a breast lift. If radiation is required, it can begin approximately 6 weeks after reconstruction.

Delayed Breast Reconstruction by Rearrangement

Delayed breast reconstruction implies a period of time has passed since lumpectomy or multiple biopsies (which can also create deformity in a breast). Radiation may have also previously been given (at least 6 months should pass before reconstructive surgery). Breast reconstruction after lumpectomy and radiation can occur at any time, and at any age.

If the breast has been previously radiated, reconstruction usually involves minor aesthetic “touch-ups” to ensure the most aesthetically pleasing shape and appearance to the radiated breast, while the other breast is either reduced or lifted to create symmetry or balance.

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Who is a Candidate for Reconstruction using a Lift or Reduction?

Any woman who requires a lumpectomy and who has large or droopy breasts, who wishes to preserve her breast tissue and receive the benefit of a breast reduction or lift is a potential candidate for this type of reconstruction. Healthy, nonsmokers with enough remaining breast tissue to rearrange after a lumpectomy are candidates for surgery. Patients with diabetes or poorly-controlled medical problems are less appropriate candidates for reconstruction. Smokers are at increased risk of complications and should quit smoking as far in advance of surgery (6 weeks) if possible.

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Is Reconstruction Still Possible If I Have Chemotherapy or Radiation?

Breast reconstruction by way of reduction or lift is certainly possible if chemotherapy or radiation have already occurred or are planned as part of future cancer treatment. Please see our section that describes Breast Reconstruction with Chemotherapy or Radiation to learn more about the timing of reconstruction with other cancer treatments.

Radiation of a breast after lumpectomy and breast lift or reduction usually creates mild shrinkage of the breast (up to 20%, but often less depending on the radiation dosage). For women where radiation therapy is planned after their reconstruction, the breast will be made approximately 20% larger than the opposite (non-cancer) breast to allow for expected shrinkage.

It takes at least six months up to a year or more for the full effects of radiation changes to be evident. Should the reconstruction change significantly after radiation, any residual asymmetry can be corrected by a minor outpatient procedure if needed for balancing.

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What are the Advantages of Local Tissue Breast Reconstruction?

Not every woman with breast cancer requires a mastectomy. Breast reconstruction using local tissue rearrangement preserves the remaining breast tissue, promoting maintenance of breast function (sensation and possibly breast feeding ability) as much as possible and the most natural and aesthetic breast shape. The nipple and areola are preserved, the tissue is rearranged to form a perkier and/or smaller breast, and reconstruction is complete in a single operation. Additional surgical stages are avoided, enabling breast cancer survivors to move forward, live life to the fullest and be proud of their breasts!

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What are Potential Disadvantages of Reconstruction by Reduction or Lift?

Most women who select a lumpectomy for their cancer treatment also require radiation therapy, which can create permanent changes in the breast shape, skin color, texture and consistency. Please see our section that describes Breast Reconstruction with Radiation to learn more about how radiation can influence breast reconstruction.

Potential asymmetry can develop after radiation to the reconstructed breast. While no two breasts are alike, symmetry is our goal for all breast surgery, including breast reconstruction by local tissue rearrangement. If necessary, a minor outpatient procedure to balance out the breasts can be done if needed once radiation-related changes are complete.

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What Actually Happens in a Breast Reconstruction by Lift or Reduction?

Please see our Preparing for Surgery section to learn about what happens in the operating room on the day of surgery.

If a lumpectomy is planned as part of the procedure, the Breast Surgeon will remove the necessary breast tissue and/or biopsy lymph nodes at the beginning of the operation. Your Plastic Surgeon will be present for the entire surgery and will perform the reconstruction and balancing procedure to the other breast at the same time.

Please see our sections on Breast Reduction surgery and Mastopexy (Breast Lift) surgery to learn about details of surgery. Any additional breast tissue removed during surgery (in addition to the lumpectomy) is also sent to the Pathology Lab for routine examination. Surgery takes 3-4 hours to complete. An overnight stay is usually recommended. If drains are used, they are usually removed by your surgeon the following morning before you leave the hospital.

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What Are Potential Risks and Complications of Reconstruction by Lift or Reduction Surgery?

When you are considering any type of surgery, you should be fully educated about potential risks and complications. Please see our Preparing for Surgery section for information relating to surgical procedures in general and Postoperative Instructions for Breast Procedures sections to learn more.

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Please click here to see before and after breast reconstruction using lift or reduction technique results!

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As women Plastic Surgeons, we intimately understand how a woman’s feelings about her breasts can influence her self-image, self-esteem and her femininity, and we aim to give you the result you are looking for! At your breast reconstruction consultation, your surgeon will spend a great deal of time with you to get to know you personally and take a complete medical history. We will explore your reasons for seeking reconstruction by way of breast reduction or breast lift, examine your breasts, and if you are an appropriate candidate for this type of surgery, your options will be described in detail.

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Download the Breast Reconstruction Planner provided by ASPS

Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA