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Tissue expanders for breast reconstruction

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

After a breast removal, also called a mastectomy, your care team may need to stretch your skin and muscle during or after the healing process to ensure there’s enough tissue later to construct your new breast.

Doctors call this a staged breast reconstruction because it’s performed in multiple steps. The stage after removal of the breast is the insertion of the tissue expanders, which make room for eventual reconstruction using your body’s own tissues or breast implants.

Mastectomies—removal of one or both breasts—may be performed to remove cancerous or potentially cancerous tissues, or as a preventative measure if you have a genetic predisposition to breast cancers. While it’s a life-saving measure, it may also be very challenging, both physically and mentally.

The decision of how and when to reconstruct your breasts and whether to opt for tissue expanders is a personal one, but it may also depend on whether you have additional cancer treatments or there’s a potential for you to need additional surgeries.

This article covers what tissue expanders are, how they’re used, what the procedure entails, and what to expect from it.

How tissue expanders are used in breast reconstruction

Tissue expanders are used after a mastectomy to increase the amount of tissue doctors have to work with when they’re recreating or implanting a breast. They may be placed during a mastectomy or in a second surgery after you’ve healed and finished cancer treatment.

To place the tissue expanders, your surgeon creates a pocket behind your chest muscle and skin. The tissue expander is like a breast implant, but it has a valve (located either inside the breast or poking out from the skin) that may be used to fill it with sterile saltwater. This is usually done throughout weeks and months, with multiple visits to your doctor.

The increasing size of the expander stretches the muscle and skin, creating a pocket of tissue into which the doctors insert the breast implant. They may also use this extra tissue to build a new breast. The surgeon removes the expander during reconstruction or implant surgery.

Factors to consider before getting tissue expanders

You may need to think about a few issues before moving forward with staged breast reconstruction and the use of tissue expanders.

  • You don’t need to decide on your reconstruction when you schedule a mastectomy. You may proceed with tissue expanders, reconstruction or breast implants after you’ve healed from breast removal. Discuss this with your doctor because you may have to wait for reconstruction if you need radiation treatment or further surgeries.
  • Decide whether you prefer adding implants or having your breasts reconstructed using fat and skin from other parts of the body. Implants typically require a quicker surgery and a shorter recovery period, and they don't leave scars in other parts of your body. But breasts made of your own tissue may be more aesthetically pleasing and feel more natural.
  • Ask yourself what size and shape you want your reconstructed breasts to be. This may determine your options for how a reconstruction may be performed. The tissue expander used should be the same shape and size as the breast implants you’re looking to insert. Breast implants come in many shapes, including round and teardrop.

In addition to these considerations, ask your doctor which types of valves are recommended for the saline expanders. These valves are used to fill the expander, and may be located inside the breast tissue or outside, which affects how the breast looks while it's in the expansion phase.

Risks of using tissue expanders

The two main risks of using tissue expanders are infection and leaking.

  • Infection is when a germ sets up shop in your body. With tissue expanders, this is likely around the area of the port, where the skin is an open wound. It’s important to keep the port clean so that germs can’t get in. If you develop an infection, doctors typically treat it with antibiotics, and they may need to remove the expanders while your body heals.
  • If the expander leaks or rips, your surgeon may need to remove and replace it.

Other safety issues with a staged breast reconstruction include the risk of undergoing anesthesia multiple times, especially for patients in poor health, with multiple health conditions, or those who are older than 65, obese or have other complications such as high blood pressure or smoking.

How to prepare for getting tissue expanders

No matter which breast reconstruction approach you select, understand that you’ll likely have to undergo multiple surgeries. Healing from surgery is more successful and quicker in patients who don’t smoke cigarettes or use other nicotine products. Consider quitting smoking and asking your care team for help if you know you’ll be undergoing multiple surgeries. It may have a real impact on your outcome and healing process.

Preparation for surgery depends on when your expanders are being inserted. The most common situation is for the expanders to be placed during the original mastectomy. If this is the case, you’ll be under full anesthesia and in the hospital for a few days while they monitor your healing and pain levels—and you likely won’t need to prepare for the expander placement specifically.

You’ll want to have plenty of soft, loose shirts and supportive (but not underwire) bras. Since you'll be slowly expanding your breast size, you may want to consider a breast form or padding to help make up the difference.

What to expect during tissue expander placement and follow-up

If you’re getting tissue expanders placed after your mastectomy has healed, you’ll likely have the procedure performed at an outpatient clinic under local anesthesia and potentially a sedative.

You may need to arrange for someone to drive you home after the expander insertion surgery, as you won’t be spending the night in the hospital.

Once the expanders are placed, they’re inflated with saltwater to about 50 percent of their final size, according to BioMed Research International.

During either the original mastectomy or tissue expander placement, you may have drains inserted into the chest area to whisk away fluids that may build up in the surgical site during the healing process. A small empty ball catches the fluid, and your care team can teach you how to empty it.

Between 10 days to four weeks after a mastectomy or insertion, plan to visit your surgeon and have a saltwater solution injected into the expander to start stretching out the tissue. This may hurt, but it should feel better in a few days. Healing after a mastectomy, reconstruction or implant, and staying comfortable during and between fills, requires some lifestyle changes. Avoid strenuous activity (no jump rope or running) and strength-building exercises that could affect your chest muscles.

Tissue expander removal

Depending on how much stretching is needed, the process of pumping up the expanders may take three to seven months.

The expansion of the tissue may make your scars look bigger, but the final insertion or reconstruction surgery should remove this scar tissue.

At some point, you’ll undergo surgery to have the expanders removed and breast reconstruction performed. If you’ve had radiation, your surgeon will also remove any scar tissue that formed from those treatments.

When the expanders are removed and replaced with implants, it will likely be done as an outpatient procedure.

You’ll need someone to drive you home once the anesthesia wears off. You should start feeling better about a week or two after implant surgery.

The surgery will be more complicated if they're using extra skin to rebuild your breasts. It will also take longer to heal, as you’ll have wounds healing where they’ve removed the tissue to rebuild your breasts.

After breast reconstruction

Your doctor may prescribe antibiotics after your final implant surgery and recommend you use a supportive bra for the first month. Avoid intensive physical activity for the first two or three weeks. You’ll likely need to have a drainage tube removed at some point post-implant operation as well.

After your breast reconstruction, it may take up to eight weeks for bruising and swelling to subside. It may take up to two years for scars to fade and the tissues to fully heal. Reconstructions, especially with breast implants, aren’t a one-and-done surgery.

  • The use of tissue expanders may cause lumpiness, though this has been improved with the development of textured expanders.
  • The use of an expander may result in asymmetry in the breasts, especially if you’ve only had a single breast removed, so future adjustments may be needed.
  • Breast implants aren’t lifelong devices and may need to be removed or replaced due to complications. You may need revisions to refine breast tissue, remove scar tissue or balance out breast size.

After your breasts have healed, you'll need to consider if and how you’d like your nipple reconstructed. You may have one built from tissue or tattooed. The nipple reconstruction is usually the last step in the staged breast reconstruction.

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