What is tissue expander breast reconstruction? When a mastectomy is required to treat breast cancer, the breast is removed, resulting in a deficit of breast and skin tissues. The missing breast tissue and skin can either be replaced with other tissues from the patient using a flap operation, or the skin stretched with a tissue expander and the volume replaced with a breast implant.
A tissue expander is a temporary breast implant device that is placed under the pectoral muscle of the chest and inflated over time to stretch out remaining muscle and skin. A material known as an acellular dermal matrix or AlloDerm® is placed to support and pad the bottom of the breast. In suitable candidates, the tissue expander is later replaced with an implant. Alternatively, the patient’s own tissues can be used later as a flap to help build a new breast. This is particularly true if radiation therapy is a part of the cancer treatment plan.
Reconstructive timeline with tissue expanders:
- First operation: Mastectomy + Tissue expander/AlloDerm® breast reconstruction(s)
- Office visits: Drain removal and wound checks, fill tissue expander(s)
- 4 months*: Exchange tissue expander with permanent implants; possible balancing procedure on other side. Possible fat grafts to optimize breast contours.
- 7 months: Nipple reconstruction. Possible fat grafts to optimize breast contours.
- 9 months: Areola reconstruction with tattoo
- 12 -24 months: Laser or IPL scar therapy .
* If chemotherapy is required, tissue expanders are usually exchanged 8 months later. If radiation therapy is also required, tissue expanders are replaced with implants or the patient’s own tissues (flap) at least 12 months later. The remaining procedures follow, in sequence thereafter.
Anesthesia: Tissue expander breast reconstruction is performed with the patient under general anesthesia.
Length of procedure: 60 minutes for one breast, 90 minutes for both breasts.
Estimated recovery time: Hospitalization is usually 1 to 2 days. You can return to work after 2 to 4 weeks and should avoid vigorous activities for 6 weeks. Visible bruising and swelling should begin to improve within 3 weeks. To learn how to prepare for a tissue expander breast reconstruction and what to expect afterwards, click here to download our patient instructions.
Side effects: Common side effects include bruising and swelling. The breast may appear deflated, misshapen and irregular immediately after surgery. This should improve as the tissue expander is progressively inflated. The tissue expander is less soft than the permanent implant that eventually replaces it. Delayed wound healing and infections may occur. Click here to download a detailed consent form from the American Society of Plastic Surgeons that lists the risks and benefits of a tissue expander breast reconstruction.
Before-and-after photos of breast reconstructions with tissue expanders and implants: Click here