If you decide to undergo breast reconstruction after a mastectomy the procedure may involve tissue expanders to stretch the skin in preparation for an implant or breast reconstruction.
Referred to as staged breast reconstruction, this process is accomplished in several steps. To understand more about tissue expanders and breast reconstruction, how it works, and how long the expanders remain in place, read on.
What Are Tissue Expanders?
Tissue expanders are used when women opt for breast reconstruction after one or both of the breasts are removed during a mastectomy due to the presence of cancer or as a preventative measure because of the existence of cancerous cells.
Used to encourage the growth of healthy skin to allow for breast reconstruction, tissue expanders typically resemble empty implants when inserted. Made from a silicone shell, they are usually smooth to touch and have an internal valve or external port through which saline fluid is incrementally injected for expansion.
Breast tissue expanders come in round, oval, and teardrop shapes to ideally match the shape of your other breast if only one breast was removed, or the desired shape for your new breasts if both were removed.
Once the skin has been stretched and enough space has been created, tissue expanders are removed and replaced with an implant or the breast is recreated using tissue from other parts of the body.
How Are Tissue Expanders Inserted For Breast Reconstruction?
It is common for tissue expanders to be placed during a mastectomy, however, in some cases, they are inserted during a second surgery after subsequent cancer treatment like chemotherapy or radiation therapy has been completed. This is something that is discussed beforehand with your doctor.
To insert tissue expanders, surgeons create a space under or over the pectoralis muscle and place the empty implant-like sac into the space. Once the expanders are in place, surgeons usually inflate them with air up to fifty percent of the desired size.
Air is used for the first expander inflation because the saline fluid, which is used later, can feel too heavy for tender chest muscles after the breasts have been removed.
How Do Tissue Expanders Work?
Approximately 10-14 days after your expanders have been placed and filled with air, your surgeon will schedule an appointment to increase their size with saline solution.
If your surgeon uses a tissue expander with an internal valve, saline with be administered via injection through the skin and into the valve. When tissue expanders are equipped with external ports, saline is injected directly into the external port.
Over the next 2-6 months, depending on the desired size, your surgeon will gradually increase the size of your tissue expanders with saline solution every few weeks to create space for an implant or breast recreation.
Are Tissue Expanders Painful?
When filled with each increment of saline solution, tissue expanders can cause an uncomfortable tightness for a day or two as the chest muscles and skin stretch.
During this time, it’s advisable to refrain from any strenuous exercise and wear loose front-button shirts or pajamas over a supportive bra with no underwire. For added relief after each tissue expander fill, many breast reconstruction patients recommend using a mastectomy pillow.
The comforting Post-Surgery Mastectomy Pillow from Intimate Rose, for instance, provides soothing protection and a general sense of comfort for the chest and underarms while also protecting surgical scars and tissue expander valves.
It also comes with supportive shoulder straps that allow you to walk around and convenient pockets for cold and heat therapy packs to relieve tightness or throbbing.
That said, if severe pain persists for more than 2-3 days after a tissue expander fill, it is always best to contact your surgeon.
How Are Breast Tissue Expanders Removed?
Approximately 4-6 weeks after the last saline fill, your surgeon will schedule an outpatient procedure to remove your tissue expanders and replace them with implants. The procedure involves an anaesthetic and usually takes one hour per breast.
If you elected to have your breasts reconstructed from body tissue, the procedure will last longer and normally includes one or two nights in the hospital.
For patients undergoing radiation therapy after a mastectomy, surgeons normally leave tissue expanders in place until the treatment is completed. They do this to ensure that they can remove any scar tissue caused by the radiation along with the tissue expander, thereby creating the best environment to receive the implant or recreated breast.
It’s useful to understand that the tissue expansion can also cause your mastectomy scars to stretch and look bigger but rest assured your surgeon will do their best to minimize this when expanders are removed and the breasts are reconstructed with body tissue or implants.
After Breast Reconstruction: What To Expect?
It can take two to three months for swelling and bruising to subside after tissue expanders have been removed and the breasts have been reconstructed. During this time you might feel vulnerable around the chest area so continue to use your mastectomy pillow as often as possible for relief, comfort, and hugs from loved ones. It’s also recommended to refrain from strenuous exercise until your surgeon gives the go-ahead for you to resume.
Once the breasts have sufficiently healed after breast reconstruction, your surgeon will likely prompt you to think about reconstructing the nipples. Choices include having one reconstructed from body tissue during an additional surgery or having a nipple tattoo done by a reputable mastectomy tattoo artist.
For information about mastectomy tattoos and what to consider before having one done, click here.
It’s also important to understand that breast implants do not last forever and usually need replacing ten to twenty years afterward. In the meantime, ensure you schedule regular checkups with your cosmetic surgeon to ensure your implants have not ruptured, deflated, or dropped.
Tissue expanders and breast reconstruction after a mastectomy is an elective procedure chosen by many cancer survivors to regain their female shape and renew their sense of confidence. Although it can be physically uncomfortable and mentally challenging, it is considered a straightforward process with minimal risks and few side effects.
If you are considering breast reconstruction with tissue expanders, read through our guide on breast tissue expanders above and make an appointment with a cosmetic surgeon in your area to discuss the options and possible outcomes.
National Cancer Institute – Breast Cancer Treatment - https://www.cancer.gov/types/breast/hp/breast-treatment-pdq
Mastectomy: What to Expect - https://www.breastcancer.org/treatment/surgery/mastectomy/expectations
American Society of Plastic Surgeons - Breast Reconstruction - https://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction
National Library of Medicine – Breast Reconstruction Expander Implant - https://www.ncbi.nlm.nih.gov/books/NBK431062/
Science Direct - Tissue Expansion For Breast Reconstruction – Methods & Techniques - https://www.sciencedirect.com/science/article/pii/S2049080117302893?via%3Dihub
National Library of Medicine - The volume of fluid injected into the tissue expander and the tissue expansion- https://pubmed.ncbi.nlm.nih.gov/25709658/
Plastic & Reconstructive Surgery - Tissue Expanders and Proton Beam Radiation - What You Need to Know - https://journals.lww.com/prsgo/Fulltext/2017/06000/Tissue_Expanders_and_Proton_Beam_Radiotherapy_.22.aspx