Achieving Breast Symmetry After Postmastectomy Radiation Through Contralateral Implant Modification Using Acellular Dermal Matrix Wrapped in a Bouffant Configuration

Radiation therapy complicates implant-based breast reconstruction by inducing fibrosis, vascular compromise, and capsular contracture, often resulting in significant breast asymmetry. Reoperation on irradiated implant pockets carries a high risk of wound-healing complications and implant loss, limiting reconstructive options. We present a case demonstrating a contralateral reconstructive strategy to address radiation-induced asymmetry without revising the irradiated breast. A woman with a history of bilateral mastectomy and implant-based reconstruction developed severe asymmetry following postmastectomy radiation to the left breast. Given the patient's preference for the irradiated breast position and the risks of operating on irradiated tissue, revision was performed on the nonirradiated side using a narrow, ultra-high-profile implant wrapped in acellular dermal matrix that was positioned cephalad. This approach restored symmetry when surgical intervention of the irradiated breast was not advised, and nonsurgical treatment of the contracted breast was not preferred. This technique avoids the morbidity associated with operating on irradiated tissue and represents a safe, reproducible treatment option for select patients.