For women who are sure that they want breast implants after their mastectomy, tissue expanders are sometimes placed within the skin to allow it to stretch slowly. Not every woman is able to get their implants as part of the initial surgery, so it’s important to know how these internal devices work and their risks. 

How does it work?

If surgeons determine that there is not enough tissue around the chest area for breast implants to go in immediately, tissue expanders made of silicone are placed instead. They may be placed at the time of the mastectomy or after healing from cancer treatment altogether. A pocket of tissue is formed behind the breast’s skin where the expander- and eventually an implant- will be placed. It has a self-closing valve so that nothing will leak out; this valve is also either placed externally or internally. The whole procedure takes about 1-2 hours for each breast. 

The first bit of saline is only injected after the surgery scars heal- typically, a month afterwards. The whole process of filling the tissue expander takes roughly 2-6 months. Women usually feel some pain or soreness after getting a saline injection due to chest muscles stretching. 

What are the benefits?

Tissue expanders are not only necessary in some cases, but they provide some benefits if you’re absolutely set on getting implants. For one, it will allow the skin to grow slowly and naturally so that there’s no discoloration when the implants are placed. There is also less risk of skin death or complications since the blood and nerve supply remain connected. Finally, due to the nature of the procedure, it leaves much less scarring than if the breast reconstruction was done right after the initial surgery. 

What are the risks and drawbacks?

Luckily, infection only occurs in about 2%-2.5% of breast implant cases, and two-thirds of these infections happen within the first few weeks of the surgery. Smooth expanders have also been reported to cause infections at a higher rate than textured implants. Unfortunately, once there is infection, the implant or expander may need to be removed for several months before a new one is placed. 

The valves of tissue expanders are made of metal, so it may be an inconvenience to deal with security when going through metal detectors. It’s a good idea to carry a doctor’s note to avoid further issues. 

Saline implants are capable of rupturing and leaking. Luckily, the body can easily absorb it and it’s not harmful, but surgery would have to be performed in order to fix it. In general, tissue expanders can make your breasts feel lumpy, uncomfortable, or asymmetrical (if you are only using one.)  

Tips for staying comfortable

Expansion takes several months, so learning to deal with your changing body can be a challenge. You’ll want to avoid strenuous exercise for six weeks after your tissue expander surgery. You may want to reduce heavy lifting and use your chest muscles for the duration of your saline injections. It is also recommended that you wear comfortable clothing and non-underwire bras. You may want to use a breast form of some kind to maintain symmetry in your breasts. 

If you find that you’re concerned about these factors, you may want to consider a “flap” breast reconstruction or simply go flat. More in-depth information on these options can be found here. We offer custom breast prostheses for women who opt out of breast reconstruction surgeries. 

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