Breast Reconstruction Expanders Removal And Replacement

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Breast reconstruction is a surgical procedure that helps women who have undergone breast cancer or trauma to their breasts. It can also be used to enlarge the breasts of women who have small breasts, in order to achieve a more natural look.

The process of breast reconstruction involves using breast implants and tissue expanders, both of which are usually inserted beneath the chest muscles. The tissue expanders are temporary devices that are inserted into the body during surgery, and they are designed to stretch out over time so that they can hold larger amounts of saline or silicone gel once they’ve been removed. In this post we’ll answer question breast expander removal surgery and also long can tissue expanders be left in.

Breast Reconstruction Expanders Removal And Replacement

Breast Reconstruction Using a Tissue Expander

This information explains how to care for yourself after your mastectomy with breast reconstruction using a tissue expander. It will also help you get ready for the tissue expansion process. A mastectomy is a surgery to remove your breast.

This information is meant to add to, not replace, discussions with your healthcare providers. Some of the information may not apply to you. Be sure to ask your plastic surgeon or nurse if you have any questions.

About Breast Reconstruction Using a Tissue Expander and Permanent Implant

A tissue expander is an empty breast implant. Your surgeon will place it during your mastectomy. The usual hospital stay after a mastectomy with breast reconstruction is less than 24 hours. That means you may go home the same day as your surgery.

Once your tissue expander is in place, your surgeon will fill it with liquid or air over about 6 to 8 weeks. As it gets bigger, it will stretch the tissue around it to make space for a permanent breast implant. For more information, read the section “What to Expect During Tissue Expansion.”

Your surgeon will stop filling your tissue expander when it reaches the breast size you agreed on. They’ll replace it with a permanent breast implant. For more information, read the section “After You Finish Your Tissue Expansion.”

Placing your tissue expander

There are 2 ways to place your tissue expander:

  • Submuscular placement is when your surgeon places the expander under your large pectoralis muscle in your chest. They will make a pocket under the muscle and place your tissue expander in that space.

    If your tissue expander is under your muscle, it will be filled with liquid. Your skin is very weak and fragile after your mastectomy. Your muscle is a barrier between your skin and the tissue expander. It helps take the pressure from the expander off your skin when it’s healing.
  • Prepectoral placement is when your surgeon places the expander over your large pectoralis muscle in your chest. They will also place a mesh called acellular dermal matrix around the expander. The mesh will help support the expander while your skin is healing. Over time, your body will absorb the mesh. It will not need to be removed.

    If your tissue expander is over your muscle, it may first be filled with air instead of liquid. Your skin is very weak and fragile after your mastectomy. Because air is less dense than water, it will put less pressure on your skin when it’s first healing. Your surgeon will replace the air in your tissue expander with liquid about 2 weeks after your surgery.

Your surgeon will talk with you about how your tissue expander will be placed during your presurgical consultation.

What to Expect After Your Mastectomy and Tissue Expander Placement Surgery

After your surgery, you’ll wake up in the Post-Anesthesia Care Unit (PACU) or recovery room. If your surgery is at the Josie Robertson Surgery Center (JRSC) you’ll wake up in your own room. You’ll have:

  • An intravenous (IV) line. You’ll get fluids, antibiotics, and pain medication through your IV.
  • Small plastic drains, called Jackson-Pratt® (JP) drains, below or near each incision (surgical cut). These collect fluid from around your incisions after surgery. They’ll be secured with a suture (stitch) and most often stay in place for 1 to 2 weeks after surgery.

Your PACU nurses will answer any questions you have.

JP drain(s)

Your nurses and nursing assistants will care for your JP drains while you’re in the hospital. Your nurses will teach you how to care for them at home. They’ll also give you the resource Caring for Your Jackson-Pratt Drain.

Your drains will be removed 1 to 2 weeks after your surgery.

Incisions

After your surgery, you’ll have a dressing (bandage) over your mastectomy incision. The dressing will have either plain gauze or gauze with clear tape. It will be held in place by a surgical bra.

The incision across your breast will be closed with sutures (stitches) placed inside your body. These sutures will dissolve and do not need to be removed. You may see some redness and slight bloodstains on the gauze pad over your incision. You may also feel tenderness and have some bruising around the incision. This is normal.

Right after your mastectomy, your reconstructed breast(s) may be smaller than your breast(s) were before surgery. This is because your tissue expander is only partly filled when it’s placed. Before you go home, look at and feel your breast and incision when your nurse is changing your dressing. This will help you become familiar with it. You may be able to feel the port that’s used to fill your tissue expander under your skin. This is normal.

Pain and sensations

You’ll have some discomfort after your surgery. You may have a stinging feeling along your incision. Your drain site(s) may itch. You may also feel some tenderness along your lower ribcage. These feelings will get better over time. You can take pain medication and a muscle relaxer when you need it, You’ll get these when you’re discharged from the hospital. Controlling your pain will help you recover better and become active as soon as possible.

Other common feelings you may have after your surgery are:

  • Numbness under your arm and over your chest on the affected side. Your affected side is the side of your surgery.
  • Warmth in your arm on the affected side.
  • A feeling of water trickling down your arm or chest on your affected side.

These are caused by nerves being cut or moved during your surgery. They’ll slowly get better over time, but some amount of numbness may be permanent.

Caring for Yourself at Home

When you leave the hospital, your incision will be covered with a gauze pad. It’s normal to see some staining on the gauze pad for 24 to 48 hours (1 to 2 days) after surgery. If you see drainage (liquid) coming from your incision, call your doctor’s office.

Wear your surgical bra 24 hours a day until your doctor gives you other instructions. Take it off when you shower.

Showering

Do not shower or get your dressing wet for the first 48 hours (2 days) after your surgery. After the first 48 hours, you may be able to take a full shower or shower from your waist down. Follow your surgeon’s instructions for how to shower. Some guidelines are listed below.

  • When you start showering, take a shower every day to help keep your incision clean.
  • Take off your surgical bra and the gauze pad over your incision before you get in the shower.
  • Check the temperature of the water first with your back or hand. Numbness may keep you from feeling heat in the affected area.
  • Wash with warm water and gentle, fragrance-free soap. Gently clean your incisions and drain sites. Rinse well.
  • Do not aim the shower stream at your reconstructed breast. Aim it at your upper back or your arm. Let the water run softly over your reconstructed breast.
  • Pat your incisions dry with a clean towel. Do not rub them.

Your healthcare provider will remove your drains 1 to 2 weeks after your surgery. Do not get your dressing wet for 24 to 48 hours (1 to 2 days) after your drains are removed. This includes taking a shower. Your surgeon will tell you how long to avoid getting it wet.

You can take a full shower 24 to 48 hours after your drains are removed. Follow your surgeon’s instructions.

Do not take tub baths until your incisions and drain sites are fully healed. Soaking in a tub may raise the risk of infection. You may be able to take tub baths about 6 to 8 weeks after your surgery. Talk with your doctor before you do.

Check your incisions and drain sites

After your shower, look at your incisions and drain site(s) carefully. To do this, stand in front of a mirror in a room with good lighting. Call your plastic surgeon or nurse if you have any of these:

  • A fever of 100.4 °F (38.0 °C) or higher
  • Increased redness of your breast
  • Increased swelling of your breast
  • New drainage from your incision
  • Bad bruising
  • More than 30 milliliters (mL) of bloody drainage in your JP drains per hour

When you finish checking your incisions and drain site, place a clean gauze pad over your incision. Put on your surgical bra.

Shaving

You can shave under your arms about 2 weeks after your surgery. Only use an electric razor on your affected side. This is to prevent getting a cut, which you may not feel due to numbness. A cut could lead to an infection.

Deodorant

Do not use deodorant until after you put your bra on. This will keep it from getting on your incision and causing an infection.

Do not use deodorant on your affected side if there is any break in the skin there.

First Follow-up Visit

Your first follow-up visit will be 1 to 2 weeks after your surgery. Your plastic surgeon’s nurse will call you after your surgery to see how you’re recovering. They’ll also schedule your follow-up visit.

During this visit, your plastic surgeon and nurse will check your breast incision to make sure it’s healing well. If you went home with a JP drain(s), your healthcare provider may remove one or more of them.

  • If your tissue expander(s) were placed below your muscle, your healthcare provider will remove your JP drain if it has less than 30 mL (1 fluid ounce) of drainage per day for 2 days in a row.
  • If your tissue expander(s) were placed above your muscle, you’ll likely have your JP drain(s) for at least 2 weeks. The amount of drainage does not make a difference.

Make sure to shower before this visit. You will not be able to shower again until after your drain site(s) heal. This is most often 24 to 48 hours (1 to 2 days) after your drain(s) are removed.

JP drain removal

Most people describe the drain removal as a slight pulling or stinging feeling that lasts only a few minutes. You will not need to take pain medication for the drain removal process.

After your drain(s) are removed, some liquid may still leak from the drain site(s). Cover the area with a sterile gauze pad or the Primapore™ dressing your nurse gave you. Change your gauze and dressing if they become damp. By that time, the drain sites are most often healed. Do not shower until your drain site are fully healed.

After the drain(s) is removed, keep wearing the surgical bra or your own supportive bra. It should:

  • Be comfortable.
  • Not be too tight.
  • Not have an underwire.

Your doctor may also have you place thick gauze pads over your drain sites for extra compression. This is to keep fluid from building up under your skin.

What to Expect During Your Tissue Expansions

During your second or third office visit, you’ll have your first tissue expansion.

  • If your tissue expander is under your muscle, your nurse will inject liquid into it through the port. They’ll use a small needle.
  • If your tissue expander is over your muscle and has air in it, your nurse will remove the air. They’ll replace the air with liquid.
  • If your tissue expander is over your muscle and has liquid in it, your nurse will add more.

You’ll have a tissue expansion visit about every week or every other week. The tissue expansion procedure only takes a few minutes. Your reconstructed breast will get bigger after each expansion. It will not take its final form until the permanent implant is placed.

How to be more comfortable between tissue expansions

After each expansion, you may feel some tightness and fullness in your breast. You may also have some discomfort in your shoulder or back. This most often gets better within a few days.

After your expansion your chest may be sore, like after you have exercised. Here are some things you can do to be more comfortable between tissue expansions:

  • Take a few warm showers a day to help relax your muscles.
  • Take over-the-counter pain medications (medication you buy without a prescription), such as acetaminophen (Tylenol®) or ibuprofen (Advil®).
  • Use a fragrance-free moisturizer (such as Eucerin® or Lubriderm®) on your breast skin. Do not put it right on your incision for 6 weeks after your surgery or until the scabbing has fully healed.
  • Do the arm and shoulder exercises your nurse tells you to do. They’ll give you a written resource with instructions. You may find it easier to do these stretches after you shower since your muscles will be more relaxed.
  • Wear soft, supportive bras. Do not wear underwire bras.

Daily activities

You can keep doing your normal activities after each tissue expansion. Follow these guidelines while you heal to stay safe and comfortable.

  • You can go back to work and do light housekeeping a few hours after your visit.
  • Do not lift anything heavier than 5 pounds (2.3 kilograms) with your affected arm for 6 weeks after your surgery. This includes lifting pets and children.
    • Check with your breast surgeon to see how many lymph nodes were removed during your surgery. This may change your lifting restrictions.
  • Do not have magnetic resonance imaging (MRI) done while your tissue expander is in place. This is because your tissue expander has a metal port. You can have other imaging tests, such as a bone scan, computed tomography (CT) scan, or x-rays.
  • Your tissue expander may set off airport security devices. Tell your healthcare provider if you plan to travel. They will give you a letter that says you have a medical device in your chest. Bring this letter when you travel.
  • Do not soak in a pool, bathtub, or hot tub until your healthcare provider tells you it’s safe. This is to lessen your risk of irritation or infection at your incision.
  • Your surgical sites may have less feeling than other parts of your body. Do not use a heating pad or hot or cold compress on them. This is to prevent burning or damaging your skin.

Exercising

  • Avoid strenuous exercise for about 4 to 6 weeks after surgery unless your doctor tells you it’s safe. For example, do not jog, jump, or run.
  • Avoid any type of exercise that will tighten or bulk your chest muscles. Talk with your healthcare provider about when you can start doing this type of exercise again.

Driving

  • You can drive when you have full range of motion in your shoulder on your affected side and are not taking any prescription pain medication.
  • When traveling a long distance by car, pad your seat belt if it falls right over your tissue expander. It’s important to wear your seat belt, so do not skip wearing it.

Clothing tips

Your tissue expander may be over-expanded. If you only had surgery on 1 of your breasts, your reconstructed breast may look bigger than your other breast as you near the end of the expansion process.

During the different stages of your breast reconstruction, you can pad your bra to help balance your appearance. One way to fill your bra is to use a soft breast form. A breast form is a lightweight nylon pouch. You can change the size to match your other breast by adding or taking out the cotton fluff inside. This is especially useful as your breast mound gets bigger during expansion.

You can also line your bra with soft gauze. You can get the gauze from your nurse. Replace the gauze every day to make sure it’s always clean.

Some other clothing tips include wearing:

  • Loose blouses, tops, and sweaters
  • Dark knit tops under a looser open blouse, sweater, or blazer
  • Tops with diagonal stripes or asymmetrical prints
  • A neck scarf or shawl
  • Button-up, loose-fitting dresses
  • Robes

After You Finish Your Tissue Expansion

Exchange surgery

Once your tissue expander reaches the right size, the next stage of your breast reconstruction will be scheduled. This stage is the surgery to replace your tissue expander with a permanent breast implant. This is called the exchange surgery.

If you are not getting chemotherapy or radiation therapy, you can have this surgery about 6 to 8 weeks after finishing your tissue expansion. If you are getting chemotherapy or radiation therapy, you will need to wait until after you finish your treatment.

During your exchange surgery, your surgeon will use the same incisions (surgical cuts) from your mastectomy. They’ll remove your tissue expander and replace it with the permanent breast implant you choose with your plastic surgeon. Your exchange surgery will take about 1 hour for each side. If a matching procedure is done on your other breast so it matches your reconstructed breast’s size and shape, it takes more time.

You’ll be able to go home once you’ve recovered from anesthesia (medication to make you sleep during surgery). This will be the same day as your surgery, most often about 3 to 4 hours after surgery.

Nipple reconstruction and fat grafting

The last stages of reconstruction include nipple reconstruction and fat grafting, if needed. Fat grafting is when fat is taken from a part of your body and injected into your breast area. It’s done to improve your breast area’s shape. The fat is most often taken from your thighs, abdomen (belly), or breast. For more information, read Fat Injection After Breast Reconstruction.

About nipple reconstruction

Some people also want to have nipple reconstruction to recreate their nipple and areola. This procedure is most often done 2 to 4 months after the permanent implant is placed. Options for nipple and areola reconstruction are:

  • 3D nipple and areola tattoo. In this procedure, a physician assistant will recreate your nipple and areola by giving you a tattoo. The tattoo will not be raised. It will have color and shading to make it look like a natural nipple. For more information, read About Your Nipple and Areola Tattoo Procedure .
  • Nipple and areola reconstruction. In this procedure, your nipple will be reconstructed using your breast skin. Sometimes, your areola will be reconstructed using a skin graft. A skin graft is when tissue is moved from one part of your body to another part during a surgery. The place the tissue is taken from is called the donor site. The place it’s moved to is called the recipient site. Areola reconstruction can be done either in the operating room or in your surgeon’s office. For more information, read Nipple and Areola Reconstruction Using a Skin Graft.
  • A blend of these 2 procedures.

Depending on your skin and type of reconstruction, 3D tattooing may be your only option for nipple and areola reconstruction. Talk with your surgeon about which option is right for you.

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How is Breast Reconstruction Using Implants Performed?

Synthetic implants are usually teardrop-shaped pouches that are placed under a layer of chest muscle to create the shape of a breast. The outside of the implant is made of silicone and it is filled with silicone gel or saline. Saline is another word for salt water. Silicone is an artificial material that feels like natural breast tissue.

The process of breast reconstruction using implants may involve one or two stages, often depending on the individual patient’s breast size. For smaller breasted women, a single stage reconstruction may be possible. With this approach, the plastic surgeon places the silicone gel or saline implant in a pocket beneath the skin and muscle layers, at the location of the new breast. This surgery is usually performed through the old mastectomy scar.

Most commonly, implant breast reconstruction is carried out in two stages. The first stage consists of placement of a device called a ” tissue expander.” An expander is a silicone-walled pouch that resembles an empty balloon with a small valve in its front wall. This valve allows the surgeon to fill the implant with saline in the weeks following this initial operation. During the second stage, the tissue expander is replaced with an implant.

During the first surgery, the tissue expander is placed in a pocket beneath a chest muscle (the pectoralis major) and the overlying skin. The tissue expander must be used to enlarge the implant pocket to accommodate the size of the implant needed to match the opposite breast. This initial surgery takes approximately one to two hours.

At the end of the surgery, the side of the chest undergoing reconstruction will still be flat. Depending on your doctor’s recommendations, this procedure can be performed on an outpatient basis or may require a hospital stay of one to two days.

Approximately 10 to 21 days following placement of the tissue expander, the process of tissue expansion will begin. Every one to two weeks, you will visit your plastic surgeon. During these 20- to 30-minute visits, approximately two to four ounces of saline (salt water) will be injected through the overlying skin into the valve located on the front wall of the tissue expander.

With each visit, the tissue expander is gradually inflated. The growing tissue expander enlarges the pocket, inducing growth of the overlying skin. In essence, this tissue expander grows the skin for the new breast. While the expansion process causes slight soreness or discomfort in some women, others report simply a feeling of “tightness” for several days following each expansion.

Approximately one to three months after the tissue expander has reached the correct size, you will undergo a second operation. During this surgery, the expander is removed and an implant is inserted in its place. The surgery lasts about one to two hours and is followed by a hospital stay of four to 24 hours.
This is done in a single operation that takes about one to two hours. Since a small implant is used, the surgeon may be able to insert it without additional operations to stretch the skin and muscles of the chest wall. The implant is placed under a layer of muscle, rather than directly under the skin, to ensure the most natural shape and feel of the reconstructed breast. This also helps to reduce formation of scar tissue around the implant.

In some smaller-breasted women, an implant may be placed in a space directly under a layer of chest muscle.

Saline vs. Silicone Implants

Should I Have a Silicone Gel or a Saline Implant?

Many plastic surgeons believe that silicone gel-filled implants have a more natural look and feel than saline implants. Silicone gel has a texture that is very similar to natural breast tissue. Saline implants, on the other hand, do not feel as soft.

However, silicone gel also has certain disadvantages. For example, silicone gel implant ruptures are harder to detect. When saline implants rupture, they flatten visibly. When silicone gel-filled implants leak, the breast often looks and feels the same. As a result, silicone gel may begin leaking into surrounding areas of the breast unnoticed. Also, replacing a ruptured silicone gel implant is more difficult than repairing a saline implant. This is because the silicone gel that has leaked outside of the implant should be removed (if possible).

There have been some reports in the media of various health problems as a result of silicone gel. In these reports, silicone gel has been associated with lupus, rheumatoid arthritis, scleroderma, neurological disorders, and other conditions. Silicone gel-filled implants were removed from the market to give scientists time to study the effects of silicone. However, researchers have found no evidence thus far supporting the connection between silicone gel breast implants and medical problems. Women who have silicone gel implants appear to have the same risk of disease as women who do not. Because of this information, silicone gel implants are beginning to be offered again by certain doctors. Still, the vast majority of breast reconstruction is done with saline-filled implants. You should be aware that even the saline implants are made of a silicone pouch filled with saline.

Advantages of Implants

  • Implant surgery requires a shorter hospital stay and shorter recovery time compared with most other reconstruction options
    Because this approach requires less extensive surgery than other reconstruction methods, usually less recovery time is necessary. If you choose to have immediate reconstruction, you will likely stay in the hospital for one to two days after the combined mastectomy and tissue expander or implant surgery. When the reconstruction is delayed, your hospital stay will probably be about 24 hours. If you have a tissue expander, the second operation, in which the tissue expander is replaced with an implant, will require a hospital stay of four to 24 hours. Although every woman’s recovery time is different, most women will be able to resume many of their regular activities after one week. After implant placement surgery, three to four weeks may be required before patients can perform more strenuous activities or return to work.
  • Implant surgery produces relatively predictable breast shapes in most women
    Since implants are made in pre-set shapes, it may be easier (compared with flap reconstructions) to predict what the reconstructed breast will look like. Therefore, you may have more realistic expectations about the surgery.
  • Implant surgery leaves fewer scars
    Reconstruction with implants usually results in only one or two scars around the breast. Often the mastectomy scar is used as the site of the new incision so you will have no additional scars after the reconstruction.

Disadvantages of Implants

  • Implant surgery may give a less natural breast shape
    It may be more difficult to ensure that both breasts are the same shape when implants are used. Implants do not allow the same degree of sculpting and shaping as natural tissue. As a result, the breast with the implant and the natural breast may not look exactly the same. Implants also do not feel completely natural to the touch.
  • Implant surgery may be time consuming and inconvenient
    If a tissue expander is needed, additional surgery and frequent doctor visits will be necessary. You must consider if you have the time and patience to undergo another surgery, hospitalization, and recovery period. You also need to think about whether you can attend doctor appointments every one to two weeks.
  • The results of implant surgery may not be immediate
    If a tissue expander is needed, you will not wake up from the initial surgery with a new breast. This can be disappointing if you are eager to see your new breast. If a tissue expander is required, it takes four to six months for breast reconstruction to be completed. During this time, one breast is bigger than the other, creating a “lopsided” effect. This may make you feel awkward or uncomfortable with your body. It may also limit the clothing you wear and the activities in which you participate. You may choose to wear a prosthesis or pad your bra to make your breasts the same size. However, this may not work if you are especially active.
  • If you have had radiation therapy, your skin may not respond well to the tissue expander
    Radiation tends to cause scarring in the radiated skin on your chest. This skin may not stretch well during tissue expansion, making the process more difficult.
  • Complications with the implant may develop
    About two to four women in 100 develop an infection near their surgical incision soon after the operation. Another two in 100 may experience bleeding (“hematoma”) or fluid collection (“seroma”) under the breast skin after surgery.
  • Implants may also develop complications over the long term
    The most common complication is leakage or rupture. This happens in approximately 10% of cases over the first 10 years. (No data yet exist to track the life of an implant after the first 10 years.) When this occurs, the implant must be removed or replaced. This surgery lasts from 30 minutes to 1 hour. It may be done on an outpatient basis or require an overnight stay. If the implant was filled with silicone gel, more extensive surgery, lasting at least one hour per implant, may be needed to remove as much silicone as possible from the breast area.

    The second most common complication is encapsulation or “capsule formation.” Scar tissue forms on the outside of all artificial implants when placed in the body. Usually, this does not pose a problem. However, in approximately 5-10% of cases, too much scar tissue forms. This may occur more frequently with silicone implants than with saline implants. The scar tissue may cause pain and discomfort and make the implant feel hard to the touch. When this happens, surgery may be necessary to break up or remove the scar tissue. It may also be necessary to remove or replace the implant. Capsules can form at any time, from a few weeks to many years after the implants are inserted.
    In about 7 cases out of 100, the implant shifts relative to the breast tissue sometime after the surgery, causing a “wrinkle” or “dent” in the shape of the final breast reconstruction (“contour irregularity”).
  • Silicone gel-filled implants are not available at all hospitals
    There have been some reports in the media of various health problems as a result of silicone gel. In these reports, silicone gel has been associated with lupus, rheumatoid arthritis, scleroderma, neurological disorders, and other conditions. Silicone gel implants were removed from the market to give scientists time to study the effects of silicone gel. However, researchers have found no evidence thus far supporting the connection between silicone gel breast implants and medical problems. Women who have silicone gel-filled implants appear to have the same risk of disease as women who do not. Because of this information, silicone gel implants are beginning to be offered again by certain doctors. Still, the vast majority of breast reconstruction is done with saline-filled implants. You should be aware that even the saline implants are made of a silicone pouch filled with saline.
  • Implants do not change to match changes in body weight
    Implants do not change size or shape. This means that the size and shape of your reconstructed breast will also remain the same, regardless of changes that may occur elsewhere in your body. Consequently, if you lose or gain weight, your breasts may seem disproportionate to your new body shape.

Implants: What are the risks?

  • Rupture and Leakage
    The silicone shell of the implant may break, causing the saline or silicone gel inside to leak out into the surrounding breast tissue. This happens to about 10% of women during the first 10 years after implant surgery. (No data exist to track the frequency of ruptures after the first 10 years.) Another surgery must then be done to remove or replace the implant.
  • Capsular Contracture
    Too much scar tissue may form around the outside of the implant, causing discomfort and making the breast feel hard. This can happen at any time, from several weeks to several years after the surgery. Another surgery must then be done to remove or replace the implant.
  • Contour Irregularity (Wrinkling)
    The implant may shift relative to the breast tissue, causing a “wrinkle” or “dent” to form in the shape of the finished breast reconstruction.
  • Infection
    The surgical incision may become infected soon after the surgery.
  • Hematoma or Seroma
    A pocket of blood (“hematoma”) or blister fluid (“seroma”) may form under the breast skin soon after the surgery.

Breast Expander Removal Surgery

Extending the chest skin little by little makes more room for a future reconstruction using an implant or your own tissue.
I perform a second surgery to remove the tissue expander and insert the permanent breast implant once the tissue has expanded to the desired size.
When switching from a tissue expander to an implant, the old expander is removed and the new implant, typically silicone but sometimes saline, is placed. That’s why we’re taking out the tissue expander and putting in a more permanent implant. It is common practice to perform this procedure through the same incision or scar as the original mastectomies. In other words, the transition from tissue expander to implant does not result in any additional scarring at the breasts. This action removes the tissue expander. Capsulotomies are used to reshape the pocket and then silicone implants are inserted. To get the inframammary fold or shelf in the right place for an implant, a surgeon may perform an internal Ryan flap. Once the implant of choice has been located, the incision can be closed. To put it simply, this is the process of switching out the tissue expander for the implant.

In order to further enhance the breasts’ overall contour and symmetry, fat grafting is frequently performed concurrently with this operation. If you want to know more about fat grafting to the breast and how to recover from it, you can watch my videos on the subject.

Recovery from Tissue Expander to Implant Exchange

When I swap out a tissue expander for breast implants, I rarely if ever need to use drains.

You can take a shower 48 hours after having your tissue expander and implant switched out.

Physical activity: After one week, you can resume most physical activity, but only if it does not involve bouncing. And for the next few weeks, I would suggest avoiding any activities that put strain on your pectoral muscles. As a result, beginning with a low-impact activity like riding a stationary bike is recommended. After 3 weeks, if the wound has healed, you can resume swimming and even snorkeling.

Bras are optional, and you can choose whether or not to wear one at any time. I may recommend a particular bra for you to wear while you heal if I had to do a lot of other things to manage where the implant will go. After having a tissue expander replaced with implants, you won’t need to wear a bra under normal circumstances.

In terms of wound care, once the Steri-Strips have fallen off, you should cover the incisions with paper tape for the first six weeks after surgery.

How Long Can Tissue Expanders Be Left In

My health insurance ends on December 31st, and I’ve had a tissue expander in for the past 10 months. I’m almost done with radiation, and I was told that I’d have to wait 3 to 6 months after radiation to do the reconstruction. Since Medicade is my only option for health insurance, I’m wondering how long I’ll have to endure the expander before I have to find a new surgeon who accepts my new insurance plan. The current one has been nothing but a source of discomfort and pain.

Tissue expanders have a long duration of action. It shouldn’t cause any issues, really. It is firmer (to accommodate the port) and more likely to rupture because it is not meant to be a permanent prosthesis. The release of saline into the pocket, even if it does happen, is usually not a cause for alarm. Although there are many benefits to upgrading to a permanent implant, patients shouldn’t feel pressured to have the procedure done immediately.

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