Whether you opt for breast reconstruction with an implant or your own natural tissue, a tissue expander may need to be put in place.
You may need a tissue expander:
- to help the skin stretch so it can adequately cover an implant because there may not be enough skin available after mastectomy
- to stretch the skin to cover implants larger than your original breasts
- to act as a space-saver and prevent the skin from scarring down to the chest wall after radiation, which can make reconstruction difficult
- if you want to “buy time” to explore your reconstruction options
The tissue expander is an empty silicone envelope with an access port. At the time of mastectomy, your plastic surgeon will place the tissue expander in a space created by your breast surgeon, under the pectoralis muscle. A graft of donated human tissue (acellular dermis) creates a sling to help hold the tissue expander in place and provides an extra layer of “tissue” between the tissue expander and skin.
Placing tissue expanders in both breasts takes about one hour and does not add any extra time to the typical one- to two-night hospital stay associated with your mastectomy. If you are having tissue expanders placed in a delayed fashion (once recovery from the mastectomy is complete), it will be an outpatient procedure, and your plastic surgeon will make an incision at your mastectomy scar.
The process of tissue expansion begins in a clinic setting two to three weeks after placement of the expander. A small needle will be placed through your skin to access the port, and saline will be added gradually to the expander. This process will be performed every one to two weeks in order to allow the skin to expand gradually over time, much like belly skin does during pregnancy. (It is normal to feel sore or tight in the days following expansion.) Patients typically need only two to three expansion visits. The number varies based on desired breast size and the final type of reconstruction chosen.
Once you are happy with your breast size, the tissue expander will be left in place for a few weeks for maximal tissue expansion. The earliest your reconstruction surgery can be performed is three weeks after your final expansion visit.
If you need chemotherapy or radiation, the tissue expander will be left in during your cancer treatments. In this case, reconstructive surgery is usually performed two to six weeks after your last cancer treatment.
Image via Johns Hopkins Medicine