Expander Implant Breast Reconstruction

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.

Summary

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 Expander Implant 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.

DTI split plane

© Image Credit

Expander OTM completely covered with a dermal matrix (beige). Saline is injected into the expander through the expander port in the office to achieve final volume.

Subpectoral Breast Reconstruction

This more traditional approach places breast implants under the pectoralis muscle (UTM). It allows for additional soft tissue beneath the reconstructed breast skin. In most cases, the muscle covers the upper part of the expander and a dermal matrix is used to support the lower half of the expander.

DTI split plane

© Image Credit

Expander partially UTM with pectoralis muscle above (red) and dermal matrix below (beige). Saline is injected into the expander through the expander port in the office to achieve final volume.

Full Submuscular Breast Reconstruction

In some cases the plastic surgeon may prefer to place the expander completely UTM with the pectoralis muscle covering the upper half and the serratus muscle covering the lower half of the expander. This may be surgeon preference or may be required in cases where the mastectomy skin is compromised.

DTI split plane

© Image Credit

Expander completely UTM with both the pectoralis and serratus muscles above (red). Saline is injected into the expander through the expander port in the office to achieve final volume.

Procedure details:

  • At the time of the mastectomy, a tissue expander is placed either over or under the pectoralis muscle
  • A dermal matrix may be used to help support the soft tissue and the expander
  • 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.