Reconstruction with Expander

Breast expanders involve the least amount of surgery of all reconstruction options, but a few considerations still need to be taken into account. Implants require both supple and sufficient tissue prior to insertion, therefore the skin that remains after mastectomy needs to stretched. Only a small sized breast can be reconstructed using this technique. This reconstruction is also not normally recommended for patients who have undergone radiotherapy.

How can I imagine the skin stretching?

The easiest way is to see this process as very similar to a pregnancy.

How does the expansion work?

This is achieved by the insertion of a balloon-type device called a tissue expander under the chest muscle. The expander has a port ( a metal or plastic plug/ valve), which allows the addition of volumizing liquid to be injected into the expander. The actual liquid saline procedure doesn't require any additional surgery but can be done at your surgeon's office. The procedure is done over a period of 3-6 months (depending on the size and skin quality) and usually at a rate of every other week. 

What happens at the end of the expansion?

Once the expansion is finalised and no other treatment is planned, the expander will eventually be replaced by a permanent silicone implant. If a Becker Expander has been used - which consists of an outer silicone gel and an adjustable saline-fillable inner lumen - then a further replacement is not necessary. In this particular instance, only the port needs then to be removed.

Is this procedure painful?

The expansion can be slightly uncomfortable. But, the more the skin softens, the less uncomfortable it gets. 
 

What are the risks?

The most important risks during the expansion are infection and/or extrusion of the implant. In the case of an infection developing which can't be treated by antibiotics, the expander might need to be surgically removed. In a case of extrusion (skin breakdown and exposure of implant), a surgical revision will also be necessary to sort it out. In the long-term, a capsular contracture (in 15% of cases) can occur, which makes an exchange of implant necessary. If the patient needs radiotherapy after reconstruction, the likelihood of capsular formation increases to 40-50%.
 

What are the disadvantages?

Next to the risks mentioned above, the cosmetic appearance can sometimes be unsatisfactory -especially if the desired size couldn't be achieved, if there's a significant asymmetry to the opposite breast or, a sense of foreign body and hardness. In general, it's fair to say that an expander-based reconstruction produces a less natural aesthetic result in comparison to other options.