This is surgery on the healthy breast to balance it with the reconstructed one. It may mean reducing it, lifting it or augmenting it, according to what is needed.
A reconstructed breast has a shape determined by the technique used, and that shape does not always match the breast that remained. When the difference is noticeable, the result when dressed is asymmetrical and the sense of "something that does not fit" persists even though the reconstruction itself is good. Symmetry surgery acts on the healthy breast to reduce that difference: it lifts, reduces or augments it as appropriate.
And here is something worth saying up front: many patients are deeply uncomfortable with the idea of operating on the breast that is healthy, the one that did not have cancer, the one that was spared. That is an understandable reaction and it is a decision that can go either way. Symmetry surgery is not compulsory and is not part of the cancer treatment; it is an optional stage whose only purpose is balance. Saying no is a valid answer too, and it compromises nothing.
It usually helps when there is
- A noticeable difference in volume, shape or height after a reconstruction.
- A dropped other breast against a reconstructed one that is higher and firmer.
- A large other breast that the reconstruction cannot match.
- A reconstruction already settled, at least three to six months on.
- The patient explicitly wanting to balance the result.
Worth discussing first if
- Reluctance to operate on the healthy breast: it is a legitimate decision and it is respected.
- A reconstruction still under way or a shape not yet settled.
- Active cancer treatment.
- High surgical risk from other conditions.
- A mild difference, which may be resolved with the right underwear.
None of these rules the procedure out on its own; all of them change the conversation.
What is done to the healthy breast
It depends on which direction the difference goes in.
Reduction
When the healthy breast is noticeably larger than the reconstructed one. As well as balancing, it usually improves back pain where there was any.
Breast lift
When the volume is similar but the healthy breast has dropped against a higher reconstructed one. It is the most frequent situation.
Augmentation
When the reconstructed breast ended up larger. An implant or fat graft is added to the healthy breast to match.
The healthy breast goes on being monitored the same
Operating on the other breast in a patient with a history of cancer has one condition: it must not make follow-up harder. Techniques are used that do not compromise the interpretation of mammograms, and all the tissue removed is sent for pathology. In a small number of cases that examination reveals findings not picked up on the previous imaging, which is an additional argument in favour when the patient was already considering surgery.
Timing matters: it waits until the reconstructed breast has reached its stable shape, between three and six months after the last stage. Matching against a shape that is still going to change means having to reoperate.
And the expectation: the goal is for the difference to stop being obvious when dressed and in underwear, not exact symmetry. A reconstructed breast and a natural one never behave the same — not when moving, not with weight, not over the years — and chasing identity leads to one operation after another with no end.
What the process is like
From the first consultation to discharge, with the usual timings for this surgery.
Consultation
The shape, volume and height of both breasts are compared standing, and the direction to act in is decided. The decision to operate on the healthy breast is discussed without pressure.
Before surgery
Laboratory tests, anaesthetic assessment and up-to-date breast imaging. The informed consent is signed.
Surgery
Under general anaesthesia. Reduction, lift or augmentation as planned, with the tissue removed sent for pathology.
Follow-up
Reviews at one week, one month and the third month, with the pathology result handed over and the usual breast surveillance resumed.
Week by week
It is the recovery of standard breast surgery, easier than the earlier stages of the reconstruction.
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Days 1 to 7
Surgical bra at all times, moderate discomfort and limited ability to raise the arms.
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Weeks 2 to 4
Back to office work at around ten to fifteen days. No lifting and no exercise.
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Weeks 6 to 12
Exercise built back up once authorised. The shape settles and the balance between the two sides starts to show.
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Months 6 to 12
Final result and scars in their last stage of fading.
Risks, and what is not promised
Those of whichever operation applies — reduction, lift or augmentation — on a healthy breast: scars that may widen or become hypertrophic, residual asymmetry, altered or lost nipple sensation, healing problems and, if an implant is used, the risks that come with it.
There is a factor specific to this situation: a breast that was healthy is being put through surgery and its risks. That is exactly why the decision is discussed unhurriedly and respected if the answer is no.
Exact symmetry is not promised. A reconstructed breast and a natural one age and behave differently, and the difference can reappear over the years. The goal is for it to stop being obvious when dressed. These risks are reduced by a technique that does not hinder follow-up and by the right surgical timing. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about symmetry surgery
No. It is an optional stage and it is not part of the cancer treatment. Many patients decide not to, and that decision is respected without pressure.
It is proposed because in some cases it considerably improves the result when dressed. If the idea makes you uncomfortable, that is reason enough not to do it.
No, if suitable techniques are used. Breast surveillance continues the same afterwards, and all the tissue removed is sent for pathology.
In fact, in a small number of cases that examination detects findings that were not visible on the previous imaging.
Once the reconstructed breast has reached its stable shape, usually between three and six months after the last stage of the reconstruction.
Doing it earlier means having to reoperate, because you would be matching against a shape that is still going to change.
No, and it is worth saying clearly. A reconstructed breast and a natural one move differently, respond differently to weight and age differently.
The realistic goal is for the difference to stop showing when dressed and in underwear. Chasing exact identity leads to one operation after another with no end.
Question not answered here? There are more answers in the frequently asked questions.
