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Case 2 and position and only after completion of any adjuvant
A 46‑year‑old non‑smoking woman, with large (C bra‑cup), therapy in order to avoid potential disadvantages. [3,4] In
ptotic (second‑degree) breasts and mid‑clavicular to contrast, Stevenson and Goldstein observed that the
[5]
nipple distance of 29 cm, underwent a right SSM‑V with combination of transverse rectus abdominus myocutaneous
axillary lymph‑node dissection for a ductal carcinoma flap reconstruction and immediate contralateral
located in the superior‑lateral quadrant, followed symmetrization neither increased morbidity nor decreased
by immediate reconstruction with a 12 cm × 18 cm aesthetic satisfaction. Losken et al. also confirmed
[6]
de‑epithelialized DIEP flap. Her NAC was grafted, and superior aesthetic results with a simultaneous approach
a contralateral mastopexy was performed in the same because the corrected opposite breast becomes the model
session. The postoperative course was uneventful. No for breast reconstruction rather than the other way around.
complications were observed in the DIEP flap, SSM‑V skin In this context, the preservation of the skin envelope and
flaps, contralateral mastopexy or at the abdominal donor inframammary fold is the key element to achieving an
site. Breast symmetry of shape and size was achieved optimal shape and size with the opposite side during the
[Figures 3 and 4]. Neither surgical revision nor secondary initial surgery. SSM‑IV, immediate autologous reconstruction
procedures were required at follow‑up of 16 months.
and contralateral symmetrization represents an excellent
single‑stage procedure for large, ptotic‑breasted patients
DISCUSSION with tumor located in IIQQ. Success of this procedure
depends on WP application to both breasts that will lead to
In unilateral breast cancer, the aesthetic quality of the the same shape, projection and degree of ptosis since the
reconstruction is also judged on the basis of symmetry preserved skin envelope is comparable between the two
of shape and size with the opposite breast. This often breasts. [7,8] Moreover, it saves the patient a second surgical
requires simple adjustments achieved by contralateral
breast reduction, mastopexy or augmentation. Factors procedure under general anesthesia with less psychological
affecting the choice of surgical procedure for the and emotional distress, while lowering operating room
contralateral side include the patient’s anatomic breast costs and time on waiting lists.
characteristics, the surgeon’s preferences, the patient’s The aim of this report was to illustrate how the same goal
desires, mastectomy type and reconstructive procedure. can be achieved in patients with large, ptotic breasts, but
The ideal time to perform symmetrization remains with tumor lying superficially in the SSQQ or deep to the
controversial due to the increased operative time and risk
of complications with immediate reconstruction. Some
argue that it is easier to adjust the opposite breast once the
reconstructed breast has reached a stable shape, volume,

a b c
Figure 1: Case 1. A 56‑year‑old non‑smoking woman with phyllodes tumour a b
(black dot) located in inferior‑lateral quadrant of the right breast and a
previous quadrantectomy scar in the upper right pole. (a) Preoperative Figure 2: Case 1. (a) Pre‑ and (b) postoperative oblique view
markings; (b) pre‑ and (c) postoperative frontal view

a b
Figure 3: Case 2. A 46‑year‑old non‑smoking woman with a ductal a b
carcinoma located in superior‑lateral quadrant of the right breast. (a)
Pre‑ and (b) postoperative frontal view Figure 4: Case 2. (a) Pre‑ and (b) postoperative oblique view
Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015 77