Question: Do you ever do anything to the opposite breast to achieve symmetry and could this hinder the ability to detect another breast cancer in the future?
Answer: We often have to do something to the opposite side to achieve symmetry, and that can be numerous things. If we do implant reconstruction on the cancer side, then we may need to do an augmentation or a breast lift or a breast lift with an augmentation on the other side. And we counsel the patient carefully about these things, because obviously, anything that you do to the non-affected breast could slightly hinder the ability to pick up another breast cancer. And so we go about it in a way to have that happen as less as possible.
An example is, for augmentation, we would always put the implant under the muscle; even if the patient might be a good candidate for it to go over the muscle, we put it under the muscle so that we would shield what mammogram can see as little as possible. Implants are thought to cause about a 15 percent decease in what mammogram can see. If you put the implant under the muscle, you shield that, or you prohibit that shielding of problem, by probably about 5 percent or so. So that your inability to see things on mammogram goes down to maybe about 10 percent.
We also will do what is called a 'mastopexy,' or a breast lift, in order to make the breast rounder and fuller, so that it compares evenly to the implanted side on the cancer side. Sometimes we will do a breast reduction; if the patient has a very large breast, you can't mimic that very well with any kind of reconstruction.
Probably the best bet for not having to do something to the other side would be using a tram flap, the flap from the abdomen, because you can get natural sagging from that and you mimic the shape and form as much as possible. However, even with that, in our many thin, healthy women who have very little flap tissue, we will often have to augment the flap in order to get it bigger, and we will often have to do something to the other side in order to get symmetry. So it's a careful balance between making sure that the cancer detection isn't harmed in a large way and making sure that the shape and form is as symmetrical as possible.