Tissue Expander-to-Implant Reconstruction

In tissue expander-to-implant reconstruction (two-stage reconstruction), an expander is placed in the breast pocket after the mastectomy and prior to the implant. Saline is then added to the expander via a port until the desired breast pocket size is achieved. This requires a second operation to later swap the expander for a permanent implant to create the breast mound.

It is important to note that when a tissue expander is being filled, the patient will often feel a stretching sensation and tightness within the breast. This can be uncomfortable for a few days, but it should not be painful. The expander is generally inflated until the new breast is just larger than the other one, and then left for a few weeks so the skin stretches. Some of the fluid is then taken out through the port, causing the new breast to droop slightly, in an effort to mirror the other breast.

Once the desired breast pocket is achieved, the expander will be taken out and swapped for the final permanent implant.

A permanent expander implant may also be utilised. Similarly, the permanent expander is gradually inflated over several weeks and left slightly over-inflated to allow the skin to stretch. When the patient is happy with the shape and size of her breast, any excess fluid is removed to try to match the reconstructed breast. The port is then taken out under local anesthetic, leaving the expander implant in place.

POTENTIAL ADVANTAGES

POTENTIAL DISADVANTAGES

Shorter operation Shorter hospital stay Quicker recovery No donor-site complications (such as muscle weakness, pain, bleeding or infection) Fewer scars May be less painful versus autologous reconstruction Avoids a second operative site Allows surgeon greater control of the final breast shape (an improved aesthetic result) Allows surgeon greater control of the final location of the implant

Possibility of multiple operations Foreign implant in patient's body could lead to complications Risk of scar tissue formation and capsular contracture (particularly in radiated breasts) Possible differences in size and shape of both breasts Bleeding, pain, wound infection and bruising may occur after operation Risk of damage or rupture of the implant Risk of infection and implant loss Risk of injection by the body Potential skin flap damage if the tissue is over expanded