- After your surgery to remove your breast (mastectomy), I will start breast reconstruction using a tissue expander.
- A tissue expander is like an empty breast implant that can be gradually filled with normal saline (salt and water) over 6-8 weeks.
- I will leave the tissue expander in place in your chest until the tissue expansion is finished.
- You will then have a second surgery called tissue expander to implant exchange, during which I will remove the tissue expander and insert a permanent breast implant.
- If you decide to have nipple and areola (the colored circle around the nipple) reconstruction, this can be accomplished 2-4 months after I put in the permanent breast implant.
One of the most common ways that breasts are reconstructed following mastectomies is starting with a tissue expander and then exchanging that tissue expander for either implants (saline or silicone) or your own tissue (such as a DIEP flap).
A tissue expander is a device that we can put in flat and later add volume. It’s something that we can control the volume of using a filling port. So, when we put it in, it usually goes in somewhat flat. This is because we don’t want to stress the fresh and fragile mastectomy skin, which is the skin that is left behind following a mastectomy. That skin is very fragile initially, so we don’t want to stress it. So, we’ll put in the tissue expanders, and over time, once it heals, we’ll access the port in the clinic and gradually add fluid to the tissue expander. It’s usually not very painful. Then we will stretch out the tissue expander until we’ve achieved your desired size. And once we achieve that size, we’ll return to the operating room and exchange the tissue expander for a silicone implant. So, that’s the purpose of a tissue expander in breast reconstruction. It is sort of a temporary place holder that we can also use to stretch out the tissue to achieve the skin envelope size that you want.
How is tissue expander breast reconstruction performed?
If it is an immediate reconstruction, which is generally the situation when tissue expanders are used, you’ll be marked before surgery by myself. The general surgeons will perform the mastectomy per those markings. When they are done with the mastectomy, then I’ll start my portion of the operation, which involves confirming that the skin can handle reconstruction at this time. I do that with a Spy Camera that tells me the perfusion of the skin. If the skin looks good enough to proceed towards reconstruction, then I will place a tissue expander in the mastectomy defect or the space left behind after your breast is removed. I will secure the tissue expander in place using your pec major muscle and an acellular dermal matrix and then sew your skin up on top of that over two drains. And that is how tissue expander breast reconstruction is performed.
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