At a Glance: This is a two stage procedure. At the time of mastectomy, surgeons place an implant that is filled over time to expand the tissue. A final implant is placed as a second procedure.
Expander implant reconstruction begins with a tissue expander, placed at the time of mastectomy. A tissue expander is a temporary implant with a built-in fill port that allows surgeons to slowly expand soft tissue. That expansion creates a pocket that is large enough to hold a permanent breast implant. This approach works well for women who do not have suitable skin quality for direct-to-implant reconstruction.
When a tissue expander is placed, it is partially filled with saline to provide the beginning of a breast shape. The expander is filled with increasing amounts of saline during office visits in the weeks after surgery. The expander implant is replaced with a final implant in a second stage procedure, after it reaches the desired volume.
Types of procedures
Prepectoral breast reconstruction: This approach places the implants in a more natural position, over the pectoralis muscle (OTM). Patients must have adequate skin quality to accommodate this newer technique.
Subpectoral breast reconstruction: This more traditional approach places breast implants under the pectoralis muscle (UTM). It allows for additional soft tissue beneath reconstructed breast skin.
- At the time of the mastectomy, a tissue expander is placed either over or under the pectoralis muscle
- Saline is injected into the expander implant through a built in port during office visits after surgery
- Patients can decide when they are happy with the volume of the expander
- Once expansion is complete, the final implant is placed during an outpatient procedure
Risks & Benefits
Placing a tissue expander requires good quality skin at the mastectomy site. Most women who undergo mastectomy are candidates for staged tissue expander-implant breast reconstruction. This approach is ideal for women who do not want to have a natural-tissue flap procedure or for those who do not have good flap options for breast reconstruction.