A tissue expander remains the most common first step in breast reconstruction with implants. It is important to understand that following a mastectomy (removal of the breast), there is removal of some skin and breast tissue. As a result, in many instances there is not enough tissue remaining to cover a fully inflated breast implant So, the remaining tissue needs to be stretched or expanded by a tissue expander over the next couple months. Several months later (4 months to 18 months later depending on the need for chemotherapy, radiation therapy or other treatments) the tissue expander is removed and the resulting stretched out pocket usually filled with a more permanent breast implant (saline or silicone). In some patients this pocket is filled with their own tissues in the form of a flap (see other links for DIEP, TRAM, latissimus, TUG flaps), or a combination of implant and flap.
Advantages of tissue expander-based breast reconstruction include relatively short surgeries (35-50 minutes to place a tissue expander), relatively short hospitalization of 1-2 nights, recovery times of 2 to 4 weeks, and absence of further surgery on other parts of the body. However, all breast implants will eventually need replacement with an average lifespan of 10-15 years. While relatively rare, infections may lead to temporary removal of the implant. Furthermore, tissue expander reconstruction is accompanied by a second surgery to exchange the tissue expander for the more permanent implant. Importantly, radiation may prevent a patient from safely having a breast implant reconstruction or increase the risk of a wound healing problem or infection in some cases.
Other procedures are available to further refine the breast including nipple reconstruction, and fat grafting. Also, matching procedures on the breast that did not require mastectomy can be performed and are covered by insurance to help restore a balanced appearance between breasts.
To learn which form of breast reconstruction is right for you, review photos, or testimonials please visit us online at westcountyplasticsurgeons.wustl.edu.