[Case Review] Liposuction to Correct Breast Asymmetry After Breast Cancer Surgery
Women who have finished breast cancer treatment often come to our clinic and tell us, "The side that was operated on became smaller, but the other side is larger and sags, so my two sides look very different." Many also ask, "Isn't it off-limits to touch the operated side again?" or "Shouldn't only the larger side be reduced?"
Today, with an actual case, I would like to explain how to correct breast asymmetry that develops after breast cancer surgery with liposuction on one side or both sides. In particular, I will focus on the fact that even on the side that had breast cancer surgery, fatty tissue still remains in the accessory breast area, the side of the breast, and the back, so liposuction can be performed there.
Why Breast Asymmetry Develops After Breast Cancer Surgery
Breast cancer surgery removes tissue from the breast that has the lesion, so the operated breast often becomes smaller or changes in shape. The opposite breast keeps its original size, and when sagging from aging is added, the differences in size and height between the two sides become more noticeable.
Fatty Tissue Remains on the Operated Side, Too
Breast cancer surgery deals with the breast tissue that has the lesion; it does not remove all of the fat layer around the breast. So even on the operated side, fatty tissue still remains in the accessory breast area above the breast, along the side of the breast, and on the back where the bra line runs. Within the breast itself, the outer part and the area in front of the armpit are regions with a high proportion of fat; fat is reported to account for about 87% of the outer breast and about 84% of the area in front of the armpit[1].
Even in breast reduction surgery, these areas tend to be left behind, so it is reported that, when needed, the breast tissue toward the armpit, the lateral chest wall, and the fat-rich upper breast are reduced separately with liposuction[2]. There is also a report that after the breast volume was reduced, the fullness of the lateral chest wall became more noticeable, and this area was contoured together with liposuction[3].
| Category | Side without breast cancer surgery | Side with breast cancer surgery |
|---|---|---|
| Breast | Original size remains; sagging is often present as well | Smaller or changed in shape because of the surgery |
| Accessory breast area, side of the breast, back | Fat remains as it was | Fatty tissue also remains on the operated side |
| Liposuction plan | Breast and surrounding areas are suctioned together to reduce the size as much as possible | The remaining fat is suctioned to match the surrounding contour and size |
The Principle of Matching the Two Sides with Liposuction on One or Both Sides
The basic approach to correcting breast asymmetry is to reduce the larger side so that it comes closer to the smaller side. If the difference between the two sides lies only in the breast itself, liposuction is done only on the side that did not have surgery. If fat also remains in the accessory breast area, the side of the breast, and the back on the operated side, liposuction is done on both sides together to match size and contour.
On the Side Without Surgery, the Breast and Surrounding Areas Are Reduced as Much as Possible
On the side that did not have breast cancer surgery, the goal is to reduce the size as much as possible in order to narrow the difference between the two sides. So we do not suction only the breast; we suction the accessory breast area, the side of the breast, and the back as one continuous line. Because correcting breast asymmetry requires matching the size of the two sides, it is one of the few exceptions at our Venus Clinic in which a larger amount is reduced on the larger side. We remove the fat that needs to go as thoroughly as possible, and we smooth the contour so that it does not look bumpy.
On the Operated Side, the Remaining Fat Is Also Suctioned
On the side that had breast cancer surgery, liposuction can also be performed on the remaining breast, accessory breast area, side of the breast, and back. If only the side without surgery is reduced, the area around the armpit and the back line on the operated side may look relatively prominent. When both sides are contoured together, it is easier to bring the lines closer together not only in the front view but also in the side view and when the arms are raised. However, the scar from the breast cancer surgery is not removed by liposuction and remains as it is.
Why Sagging Can Also Improve
When liposuction reduces the volume of the breast, the skin covering it also contracts to fit the reduced volume. The more evenly suction is performed close to the layer just beneath the skin, the more readily skin contraction occurs, and an effect of the breast being lifted upward as the skin contracts has been reported[4]. A prospective study of breast reduction by liposuction likewise reported that breast sagging (ptosis) improved after surgery[5].
At our Venus Clinic, we call this superficial liposuction, and we use it as a way to reduce the size of a sagging breast and improve the sagging together, without making a separate incision.
Skin Contraction Varies from Person to Person
The degree of skin contraction depends on skin elasticity, age, and the amount of volume reduced. Suctioning the superficial layer too aggressively carries a risk of skin damage, so it is reported to be important to leave the remaining fat layer even[4]. The degree to which sagging improves differs from person to person.
What to Check Before Surgery, and the Limits
Please Talk with Your Treating Doctor First
Your treating doctor knows best the course of your breast cancer treatment and your upcoming follow-up schedule. It is best to decide the timing of surgery after discussing it with your treating doctor. Please continue to attend your scheduled regular check-ups after surgery, and when you have breast imaging, letting the staff know that you have had breast liposuction will help with the reading of the images.
Closer to a Similar Size, Not an Identical Size
The breast contains glandular tissue that liposuction cannot reduce, and the proportion differs from person to person. In addition, on the side that had breast cancer surgery, the surgical scar and the changes in shape remain as they are. So it is more accurate to understand this surgery not as one that makes both sides completely identical, but as one that reduces the noticeable difference in size so that the two sides come closer to a similar size.
If Your Weight Changes, the Size Can Change, Too
Even if liposuction reduces the number of fat cells, the remaining fat cells can grow larger again if you gain weight. The breast has a high proportion of fat, so if you gain weight after surgery, the breasts can also grow larger, and the change may appear differently on the two sides. Managing your weight steadily after surgery helps you maintain the matched size for longer.
References
- Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. Mosby; 2000. Chapter 38.
- Lista F, Ahmad J. Vertical scar reduction mammaplasty: a 15-year experience including a review of 250 consecutive cases. Plast Reconstr Surg. 2006;117(7):2152-2165.
- Price MF, Massey B, Rumbolo PM, et al. Liposuction as an adjunct procedure in reduction mammaplasty. Ann Plast Surg. 2001;47:115-118.
- Shiffman MA, Di Giuseppe A (eds). Liposuction: Principles and Practice. Springer; 2006. Chapter 36, 62.
- Moskovitz MJ, Baxt SA, Jain AK, Hausman RE. Liposuction breast reduction: a prospective trial in African American women. Plast Reconstr Surg. 2007;119(2):718-726.
Before-and-After Photos
The three photos below show one patient who underwent liposuction for breast asymmetry correction at our Venus Clinic, photographed from the front, the left oblique view, and the right side. She had breast cancer surgery on the left breast, and liposuction was performed not only on the right breast, which did not have surgery, but also on the breast, accessory breast area, side of the breast, and back on the operated left side. All of the after photos were taken one week after surgery. Swelling and bruising are still present at this stage, so this is not the final result, and the yellowish discoloration you can see is bruising in the process of fading, which becomes lighter over time.
Front View
This is a case with breast cancer surgery on the left breast. Before surgery, the left breast was small with a breast cancer surgery scar above the nipple, while the right breast was large and drooped downward, so the differences in size and height between the two sides were clear. In the photo taken one week after liposuction on both sides, the two breasts have come closer to a similar size, and the right breast that had been drooping has been lifted upward as the skin contracted, showing improved sagging.
| Information on the Posted Liposuction Before-and-After Photos | |||
|---|---|---|---|
| - Same person | Surgery performed at Venus Clinic; same person | - Date taken | Taken around 2023; comparison at 1 week after surgery |
| - Same conditions | Edited to the same posture and size as closely as possible | - Side effects | https://en.myvenus.co.kr/should_know/38861 |
Left Oblique View
This is a case with breast cancer surgery on the left breast. Seen from an angle, before surgery the right breast was larger than the left and hung down long. One week after surgery, the volume of the right breast has decreased and it has moved upward, so the differences in size and height between the two sides are smaller. Swelling is still present, so the shape will change a little more over time.
| Information on the Posted Liposuction Before-and-After Photos | |||
|---|---|---|---|
| - Same person | Surgery performed at Venus Clinic; same person | - Date taken | Taken around 2023; comparison at 1 week after surgery |
| - Same conditions | Edited to the same posture and size as closely as possible | - Side effects | https://en.myvenus.co.kr/should_know/38861 |
Right Side View
This is a case with breast cancer surgery on the left breast. Seen from the right, before surgery the right breast, which did not have surgery, was large and drooping. One week after surgery, the right breast has become smaller and the lower line of the breast has moved upward, so the drooping shape has improved naturally.
| Information on the Posted Liposuction Before-and-After Photos | |||
|---|---|---|---|
| - Same person | Surgery performed at Venus Clinic; same person | - Date taken | Taken around 2023; comparison at 1 week after surgery |
| - Same conditions | Edited to the same posture and size as closely as possible | - Side effects | https://en.myvenus.co.kr/should_know/38861 |
In Closing
Breast asymmetry after breast cancer surgery does not have to be handled by reducing only the side that did not have surgery. Fatty tissue also remains in the accessory breast area, the side of the breast, and the back on the side that had breast cancer surgery, so liposuction can be performed there, and liposuction on one or both sides can bring size and contour closer together while also improving the sagging of a drooping breast. We believe the goal of this surgery is to help women who have been through major treatment feel comfortable putting on their clothes and standing in front of the mirror again.
Dr. Hakjun Kim, Director, Venus Clinic
