The most common method of breast reconstruction currently performed in the United States uses tissue expanders and breast implants placed in a staged fashion.
This is usually performed as a multiple-step procedure beginning with the placement of tissue expanders (first stage), which are placed at time of the mastectomy and partially filled with air or saline, to recreate a small breast mound. Once completely healed from the mastectomy procedure, your surgeon will perform in-office filling of the tissue expander, allowing the tissue expander to increase in size and shape. Upon completion of all breast cancer treatment, your tissue expanders are replaced with breast implants in a subsequent (second stage) outpatient surgery.
The first stage involves placement of tissue expanders either below (subpectoral) or above (prepectoral) the pectoralis muscle. This is done at the same time as the mastectomy procedure, also called immediate reconstruction. The expanders are often partially filled to maintain some breast volume. Because expanders implants are temporary implants that function to occupy or expand the space below the skin. This allows the patient to heal following mastectomy and complete any further breast cancer treatment (which may include chemotherapy or radiation).
Once the incisions have healed, your surgeon will begin the tissue expander filling process (with sterile saline or air), which is performed in the office. The expansion process may require multiple office visits, and varies depending on the volume required to achieve an optimal breast shape and size.
Upon completion of the tissue expansion process and all other breast cancer treatment (chemotherapy and/or radiation therapy), your tissue expanders will be replaced with breast implants in a subsequent (second stage) outpatient surgery. There are two types of breast implants available to patients: saline or silicone. It is advised that you speak with your plastic surgeon as to which implant would be best for you. When planning your second stage, speak to your patient about including fat grafting at the same time of your implant exchange. This may improve the skin and soft tissue of the breast, creating a thicker “padding” and more natural contour over the final implant. Thickening the layer of fat below the skin of the breast improves the appearance of the skin, improves any contour irregularities following mastectomy, and can camouflage any implant “rippling” or appearance of waves along the surface of an implant.
Expander Implant
Duration of Tissue Expander Filling: Done at intervals over one to three weeks during the healing process, with each expansion taking about one minute.
Pain during Tissue Expansion: Limited discomfort, with the patient’s skin tightness influencing the saline volume at each visit.
Chemotherapy and Tissue Expansion: Coordination is possible, but the second reconstruction stage must be delayed until after completing chemotherapy.
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