Medical Oncologist
Reconstruction
Balancing surgery on the other breast
The healthy breast can be lifted, reduced or enlarged to match a reconstructed side, and for many women it is what makes a one-sided reconstruction look right in clothes. It is usually a separate, later operation, done once the reconstruction has settled into its final shape.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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The short answer
Can the other breast be adjusted to match?
Yes, and for many women it is what makes a one-sided reconstruction look right in clothes. The healthy breast can be lifted, reduced or enlarged to match the reconstructed side. It is usually done as a separate, later operation.
Why the two sides rarely match on their own
A reconstructed breast does not droop, does not change with weight in the same way, and sits differently on the chest. Your natural breast continues to behave naturally. Over a few years the gap between them widens rather than closes.
Why it waits
The reconstruction has to settle into its final shape first, and if you are having radiotherapy that has to finish. Matching to a shape that is still changing means matching to the wrong target.
It is part of the reconstruction, not vanity
Women frequently apologise for asking. Balancing the two sides is a recognised stage of breast reconstruction and is offered routinely at centres that do this work properly. Ask about it early even though it happens late.
Check cover in writing. Surgery on the unaffected breast is sometimes classified separately.The options
What can be done to the other side
Which one suits you depends on your natural breast, not on the reconstruction.
A lift
Raising and reshaping a breast that has dropped, without changing its size much. The commonest choice where the natural side sits lower than the reconstruction.
A reduction
Removing tissue to match a smaller reconstruction. Many women find this improves comfort as well as symmetry, particularly with larger breasts.
Tissue removed is examined in the laboratory as a matter of routine.An enlargement
An implant placed in the natural breast to match a larger reconstruction. Less common, and it means accepting an implant in a breast that did not need surgery.
Adjusting the reconstruction instead
Sometimes the better answer is to change the reconstructed side, by fat grafting or revision, rather than operating on a healthy breast. Ask whether that is possible for you.
Worth asking
- Which side should be adjusted
- When is the right time
- What is covered by my scheme
The timing
When it fits into the sequence
-
The mastectomy and reconstruction
The main operation. Symmetry is occasionally addressed at the same sitting, but usually deferred, because the reconstructed side will change considerably.
-
Radiotherapy, if you need it
This changes the reconstructed side over months and sometimes years. Matching before it has settled is matching to a shape that no longer exists.
-
Settling
Several months at minimum, often a year, for the reconstruction to reach its final position. Implants in particular sit high at first and drop over time.
-
Assessment standing up
You are examined and marked upright, because the difference between the two sides is largely about how they behave under gravity. This appointment is where the plan is actually made.
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The balancing operation
Usually a day case or one night, with a shorter recovery than the reconstruction itself. Often combined with nipple reconstruction on the other side.
Not sure whether this applies to you?
Ask an oncologistWords you will hear
The vocabulary, in plain language
- Symmetrisation
- Surgery on the unaffected breast to match the reconstructed side. Also called balancing surgery.
- Mastopexy
- A breast lift. Raises and reshapes without removing much volume.
- Reduction mammoplasty
- A breast reduction. Removes tissue and reshapes, often improving comfort as well as symmetry.
- Augmentation
- Enlarging the natural breast with an implant to match a larger reconstruction.
- Contralateral
- The other side. Here it means the breast that did not have cancer.
- Ptosis
- Natural drooping of the breast. The usual reason the two sides stop matching over time.
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Side by side
Why the two sides diverge
Your natural breast
The reconstructed side
Droops gradually with age
Holds its position, particularly with an implant
Changes size with weight
An implant does not; transferred fat does
Softens and changes after menopause
Stays much as it was
Moves naturally when you lie down
Stays where it is placed
Continues to need screening
Usually followed by examination alone
Being straight with you
What balancing surgery does and does not solve
It makes the two sides look considerably more alike in a bra and in clothes, which for most women is the point. It does not make them identical undressed, and it does not stop them diverging again over the years.
It is surgery on a healthy breast
That deserves stating plainly. It carries the usual risks of an operation, it leaves scars on a breast that had none, and it can affect sensation, particularly a reduction. Weigh that against how much the asymmetry actually troubles you.
Screening continues either way
Your natural breast still needs its yearly mammogram whether or not it has been operated on. Surgery changes its appearance on imaging, so the first mammogram afterwards becomes the new baseline for comparison.
They may drift apart again
A lifted or reduced breast continues to age and can drop again over years, while the reconstruction stays put. Some women have a second balancing procedure much later. Ask your surgeon what to expect over a decade rather than a year.
You can decide not to
Plenty of women live comfortably with two different-looking breasts, using a partial prosthesis in a bra if they want symmetry in clothes. Declining is a legitimate choice, not a failure to complete something.
Commonly believed
What women say about asking for this
Asking to match the other side is vanity after cancer.
Balancing surgery is a recognised stage of breast reconstruction, offered routinely where this work is done properly. How your body looks affects how you live for decades. Raising it is reasonable rather than indulgent.
Operating on the healthy breast raises cancer risk there.
A lift or reduction does not raise the risk of developing breast cancer. Tissue removed at a reduction is examined in the laboratory as a matter of routine, which occasionally finds something unexpected and useful.
It should be done at the same time as the reconstruction.
Usually it should not. The reconstructed side changes for months, and after radiotherapy for years. Matching early means matching to a shape that will not last, and often needing the operation again.
Surgery on that side means I can stop having mammograms.
No. Your natural breast still needs screening whether or not it has been reshaped. What changes is its appearance on imaging, so the first mammogram afterwards becomes the new baseline for comparison.
Questions we are asked
Common questions about balancing surgery
How long after my reconstruction can I have it?
Usually several months to a year, once the reconstruction has settled into its final shape, and after radiotherapy has finished and its effects have stabilised. Matching earlier than that generally means doing it again later.
Will it affect sensation in my natural breast?
It can, particularly a reduction, where nipple sensation is sometimes reduced or lost. A lift carries less risk. Ask your surgeon specifically about this, because it is a real cost of operating on a breast that currently feels normal.
Can I still breastfeed afterwards?
A reduction can affect the ability to breastfeed, and a lift is less likely to. If future pregnancy is possible for you, say so before the operation, because it may change the technique or the timing.
Is it covered by insurance or a scheme?
Cover varies and surgery on the unaffected breast is sometimes classified separately from cancer treatment. Get written confirmation before booking rather than assuming it follows the reconstruction.
What if I would rather adjust the reconstruction instead?
That is often possible and sometimes better, using fat grafting or a revision rather than operating on a healthy breast. Ask which side your surgeon thinks should change, and why.
Will the scars be obvious?
A lift or reduction leaves scars around the nipple and usually below it. They fade over a year or more but do not disappear. Ask to see photographs of the scar pattern being proposed rather than imagining it.
Could they drift apart again?
Over years, yes. A natural breast keeps ageing while a reconstruction does not. Some women have a further balancing procedure much later. Ask what your surgeon expects over a decade rather than the first year.
Is there an alternative to surgery?
Yes. A partial prosthesis worn in the bra balances the shape in clothes without any operation, and many women find that entirely sufficient. Ask your breast care nurse about fitting one before committing to surgery.
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Sources
- Cancer Research UK — Breast reconstruction
- National Cancer Institute — Breast reconstruction after mastectomy
- Breast Cancer Now — Surgery to the other breast
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.