This procedure can be performed immediately (at the time of mastectomy) or delayed (weeks to years after the mastectomy).
The aesthetic goal of a tissue expander or implant reconstruction is to “look good in a bra.” These devices do a good job of recreating a breast mound and filling a bra. Tissue expanders and breast implants are a good option for smaller breasted women who do not have a lot of excess tissue for flap reconstructions. Expanders/implants do not exactly replicate large hanging breasts and, therefore, are not the best option for patients with larger, droopy breasts or for patients who desire a more “natural” look. Expander/implant reconstructions are ideally suited for patients who are having both breasts reconstructed but also can be done for unilateral reconstruction as well. Expander/implant reconstructions are also best suited for smaller breasted women. It is often easier to achieve breast symmetry when reconstructing both breasts using this technique.
A tissue expander is an elastic, silicone, rubber device placed under the breast skin and pectoralis muscle often in combination with an additional soft tissue material (Alloderm*, FlexHD, etc.) to support and maintain the position of the expander. A single side reconstruction takes about an hour to two hours and bilateral reconstructions may take up to three hours. The hospital stay is usually one to two nights. Recovery is around two to three weeks.
After the Placement of Your Expander
Starting about three weeks after placement of the expander, our plastic surgeon, Dr. Max Lehfeldt, or his Physician Assistant, Vangie Luong, will start filling the expander with sterile saline via a small needle inserted through the skin (breast skin is usually numb following mastectomy). You may experience feelings of pressure or discomfort after each filling of the expander (similar to the aches and pains following a vigorous workout). These feelings last only a few hours and are easily managed with ibuprofen. Dr. Lehfeldt’s use of soft tissue supports in tissue expander breast reconstruction allows him to fill the expander a minimum of 50% at the time of surgery/reconstruction and sometimes more. This expansion at the time of surgery often improves the breast shape right away and further reduces the number of visits required to expand and fill the tissue expanders. Often patients can be fully expanded in less than 2-3 visits! This shortened time interval has great psychological benefits for patients.
Gradually, the tissue over the tissue expander device expands, stretches, and creates a pocket for the breast implant. The permanent breast implants are usually inserted 3 months after the expander was placed. The most commonly used breast implant following expansion is a cohesive silicone gel implant – the Allergan Natrelle® 410 implant. Saline (saltwater solution) implants are also available but may not provide the best aesthetic outcome. Dr. Lehfeldt will evaluate your shape and desired breast volume to help determine the appropriate implant. The beauty of an expander/implant reconstruction is that you, the patient, can actively participate in the process and have the opportunity to decide the size of breast you want!
Please call 888.96.DR.MAX (888.963.7629) or email to make your appointment today and to see if tissue expander breast reconstruction with Dr. Lehfeldt is right for you!
*Use of Alloderm or Strattice in breast surgery (cosmetic or reconstructive) is not approved by the FDA. Use of these materials in breast surgery is considered an off-label use.