Tissue expander breast reconstruction is sometimes referred to as “delayed implant reconstruction” or “two-stage implant reconstruction.” It is a favorable method for those patients who do not have enough of their own breast tissue from which to reconstruct.
It is also recommended for women who have other health issues which would prevent them from the longer surgery time associated with flap reconstruction.
Tissue Expander Breast Reconstruction is when a tissue expander is placed beneath the skin and muscle of the chest. A tissue expander is a balloon-like mechanism that can be inflated with saline over time to stretch the breast tissue and skin to the desired size and shape.
There are two main stages of tissue expander breast reconstruction: Tissue expansion and implant surgery.
During the first stage of the tissue expander reconstruction procedure, our board-certified breast reconstruction surgeon will place the tissue expander within the chest wall and beneath the tissue and muscle. Your doctor can either work alongside your breast surgeon during the mastectomy to place the tissue expander or later down the line, dependent on your situation. The mastectomy and tissue expander placement together will take two to four hours and you will be under general anesthesia.
About seven to ten days after surgery, your doctor will begin the expansion of the tissue expander. The tissue expander has a port built into it that will be accessed to add more saline until desired size is reached. During a period of several weeks to a couple of months, saline is added in one to two week increments until the preferred volume is reached.
The second step of tissue expander breast reconstruction is the implant or exchange surgery which is usually scheduled for three to six months after the tissue expander’s initial placement and four weeks after the last and final saline expansion session. This surgery takes about one hour and is performed under local or general anesthesia.
The scheduling of this surgery also depends on the need for radiation as it may be necessary to wait and continue radiation prior to exchanging the tissue expander for the final implant.
After the balloon-like tissue expander is placed, you will immediately notice that your breast has shape and curve. Most patients will stay overnight and return home the day after the surgery. You will be given antibiotics and instructed not to do any lifting or strenuous activity for the first week or so. It will be imperative that you have help around the house for the first week or so as you will not be able to do most chores. You will also need to keep a close record of the drainage which helps the doctor determine when they can be removed.
During the saline expansion sessions, you will experience some pain and tightness. It is advised to take an over the counter pain medication before each session to help alleviate any aching or soreness associated with the tissues expanding.
The implant or exchange surgery is often a day surgery with a shorter recovery time than the initial tissue expander surgery. You may stay one night or return home the same day. You will feel some aching for one to two weeks.
Similar to the first surgery, you will need some help for the first week as you won’t be able to do any lifting. You will be prescribed antibiotics and painkillers to take afterward and will need to avoid any strenuous activity for a couple weeks after surgery. The incisions should heal within two to three weeks but it may take up to six weeks to return to normal activity and dependent on radiation and chemotherapy, up to 12 months to feel fully recovered.
The placement of the tissue expanders can be decided upon by you our plastic surgeon at Arizona Aesthetic Associates. It’s usually easier to place them as the same time as the mastectomy but it depends on what you need in future cancer treatments. If they are placed at a later date, our breast reconstruction surgeon will use the same incisions as used for the mastectomy to avoid added scarring.
The tissue expander is a balloon-like mechanism that is used to slowly stretch the tissue in order to make room for an implant. It is usually a bit harder and less comfortable than an implant. An implant, usually made of silicone, is softer and more natural looking and feeling.