Breast reconstruction is a complex procedure with many steps and options. After mastectomy, the patient can choose from a variety of different kinds of breast prostheses, including silicone gel implants, saline-filled implants, or tissue expanders.
Of these three options, tissue expansion requires the most preparation and follow-up care, but it also offers the most natural-looking results. Tissue expanders are used to gradually stretch out the skin around the breast and create space for an implant.
The first step in this process is to insert an expander device through a small incision under the ribcage. The expander device is filled with saline solution as needed to gradually stretch out the skin over time. Over a period of weeks or months (depending on how much skin needs to be stretched), the expander will be removed and replaced with a permanent implant that has been shaped to match your chest wall contour and size requirements.
Breast Expander Implants
Many women who undergo mastectomies opt for breast reconstruction. AlloDerm® Regenerative Tissue Matrix, which is manufactured by LifeCell, is frequently used during the reconstruction process. AlloDerm tissue can replace some of the breast tissue removed during surgery and provide support for implants.
It is created by taking tissue from a carefully screened donor (cadaver), and then putting the tissue through a cell-removal process that reduces the likelihood of rejection, yet leaves the basic tissue structure intact. Because it is produced from natural human tissue, it is not only well tolerated, but actually grows into the patient’s tissue for a strong, natural repair. The product is also used for some types of head and neck plastic-surgery reconstruction, and for hernia repair. According to its manufacturer, AlloDerm Regenerative Tissue Matrix has been used successfully in more than one million grafts and implants.
Breast reconstruction may be done in one step or two, with the two-step procedure used in the majority of cases.
Two-Step Procedure
In the two-step procedure, a new breast is created by first using a tissue expander, which is a temporary implant filled with saline. By periodically injecting more saline into the tissue expander, the skin stretches to create a soft pocket designed to hold a permanent implant. The tissue expander is put in place right after the breast is removed. To stabilize the tissue expander, it is placed under AlloDerm tissue, which is sewn from the pectoralis major muscle to the chest wall.
Breast skin then grows into the AlloDerm tissue, which forms an extra protective layer between the implant, when it is inserted, and the surface of the breast. The AlloDerm tissue is positioned to provide the correct shape and foundation for the implant.
In the second stage of the procedure, which takes place approximately 12 to 24 weeks after the skin is sufficiently expanded, the permanent implant is inserted.
Single-Step Procedure
In the single-step procedure, a breast is created at the time of removal. AlloDerm tissue is sewn to the chest muscle to provide a hammock-like support for the implant. The AlloDerm tissue is essentially making the chest-muscle space larger, allowing a permanent full-sized breast implant to be inserted without having to use a tissue expander. The single-step procedure works best for women with small to moderate-sized breasts and good-quality skin tissue, and who are having mastectomies when their cancer is in its early stages. Women having preventative mastectomies because they are at high risk for breast cancer are also good candidates.
Breast Expander Removal Surgery
Removing the breast implants that were inserted for reconstruction or augmentation is the main objective of breast implant removal surgery, also known as breast expander removal surgery. It is common practice to do this procedure when the patient desires the expanders removed or when complications arise that necessitate their removal.
During the surgery, the surgeon will make an incision in the breast area to remove the expander. The next step is the careful removal of the expander along with any surrounding scar tissue or debris. In most cases, patients are allowed to return home the same day after their incisions are sewn.
There are a number of factors that could lead individuals to contemplate breast expander removal surgery. Just a handful of these clarifications:
– Dissatisfaction with the size or shape of the breasts after reconstruction or augmentation
– Complications such as infection, capsular contracture, or implant rupture
– Personal preference to return to a more natural look and feel
To have a breast expander removed, it is best to visit a board-certified plastic surgeon who specializes in breast augmentation and reconstruction. The ideal course of therapy is determined by taking each patient’s unique needs into account.
Most patients say they feel considerably better and can get back to their normal lives within a few days after having a breast expander surgically removed. The surgeon will give you specific postoperative recommendations to follow so that you can heal quickly and with few problems.
A typical surgical technique involves removing breast expanders. They may be able to accomplish their fitness goals with this in case complications emerge during breast growth or repair. Patients who seek out a trained plastic surgeon and strictly follow their post-operative recommendations may find their self-esteem restored and their expectations fulfilled.
How Long Can Tissue Expanders Be Left In
One question that people often have about tissue expanders is how long they can stay in place. In breast replacement surgery, tissue expanders are often used to make room for a fixed breast implant. These devices are only used temporarily and are usually taken off once the tissue has grown as much as needed. However, tissue expanders may need to stay in place for a long time in some situations.
Different patients and their unique situations will have different limits on how long tissue expanders can be left in place. Tissue expanders can usually stay in place for a few months to a year. There are times, though, when tissue expanders need to stay in place for longer, like two years or more.
Your doctor may tell you a different amount of time to leave tissue expanders in place. Some of these factors are:
- The amount of tissue expansion required
- The patient’s overall health and healing ability
- Any complications that may arise during the tissue expansion process
Patients should follow their doctors’ orders on the duration of time tissue expanders should be left in place. Too much time with tissue expanders in situ increases the risk of complications including infection or tissue damage. It is common for tissue expanders to remain in place for five to twelve months. However, there are cases where they may need to remain stationary for a longer period of time. The patient and operator should collaborate to determine the optimal duration of tissue expander placement.