Tissue Expansion~

 

Expander Implant
Post Mastectomy Reconstruction

Post mastectomy reconstruction with a tissue expander and implant involves a staged approach. A tissue expander is a temporary device that is placed on the chest wall deep to the pectoralis major muscle. This may be done immediately following the mastectomy, or as a delayed procedure. The purpose of the expander is to create a soft pocket to contain the permanent implant. Tissue expanders are available in a variety of shapes and sizes.

Placing the Expander

At the time of the initial post mastectomy reconstruction operation, when it is first positioned on the chest wall, the tissue expander is partially filled with saline. Within a few weeks after this surgery, once the patient has healed, expansion can be started as an office procedure. The process of expansion takes place at one, two or three week intervals over several months. The timing of expansion can be coordinated with chemotherapy treatments. The amount of fluid that is placed into the expander at the time of the initial surgery will also determine how many expansions are later required. Today, with the use of a dermal matrix (such as AlloDerm®), the surgeon can usually place a higher volume of saline during the initial surgery. This may decrease the number of expansions needed later. The patient will be well on her way to having an immediate breast shape after the first operation.

Most expanders have a fill port that is built into the front of the device. This port is accessed with a needle through the skin. Expansion takes about one minute, and the amount of fluid that is placed is limited by the tightness of the patient’s skin. A typical volume for each expansion procedure is 50 cc's of saline (an equivalent of 10 teaspoons). Most patients do not have significant discomfort or pain after expansion. Discomfort can generally be managed with Tylenol, and the tightness should subside within 24 hours. 

Once expansion is completed and the patient is medically cleared for another operation (about one month after chemotherapy), the second stage of reconstruction is performed. This is an outpatient procedure that involves exchanging the expander for an implant, and creating a more refined breast shape. The initial tissue expander placement, and subsequent exchange for an implant, each take about one hour in the operating room.

This is the procedure that I am currently in the middle of.

Information courtesy of  BreastReconstruction.org